Ep 022: CBD and Vaping--with Dr. Deng

 
www.deepintosleep.co

Dr. Huiqiong Deng

with Dr. Yishan Xu

 

TODAY’S GUEST


Dr. Huiqiong Deng is a Clinical Assistant Professor, from Stanford Psychiatry and Behavioral Sciences. Addiction treatment is one of her specialties.


RESOURCES

The FDA has the authority to control e-cigarettes.

FDA's Deeming Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products

https://www.drugabuse.gov/publications/research-reports/marijuana/letter-director

By NIDA

https://cannabisandpsychosis.ca/

This website is a project of the Schizophrenia Society of Canada.

Lancet Psychiatry Review

Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis.

Hill KP. Medical Use of Cannabis in 2019. JAMA 2019.

Thank You for Listening!

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Transcript

Unknown Speaker  0:02  

Welcome to deep into sleep with Dr. yishan xu. Matz, improve sleep quality and live a healthy life together. Let's go deep into sleep. And now please welcome your host each on.

Unknown Speaker  0:19  

Hello, welcome to deep into sleep. This is Asian. So because I treat insomnia in my clinical work, I often get this question that if I use CBD oil, will that help me to sleep or a lot of patients will say well I use marijuana to help me feel relaxed so I can sleep better. So in reality from a scientific view, it's CBD or vaping or this different products related to marijuana. Can they really help us with sleep or do they do more harm than Good or more good than harm? I'm always confused about this question myself. So today, I invited Dr. Twitchell don't from Stanford to share her expertise in this area with us. Dr. Dawn is a clinical assistant professor of psychiatry in Stanford Medicine Center. She is specializing in the treatment of alcohol and substance addiction and interventional psychiatry. Her goal is to help each patient along their journey to achieve optimal health and quality of life. Dr. Dawn has both MD and a PhD degree and she does a lot of great research. So I feel like she had a lot of great knowledge in this area. And she gave a lecture to my clinic. We all felt like we learned so much from her. So I really want to pass this great information to the public. Hopefully you all can benefit from her expertise in this area.

Speaker  2:06  

Hi, Dr. Don, welcome to the pain to sleep.

Unknown Speaker  2:09  

Thank you so much for having me.

Unknown Speaker  2:12  

So I know you are specialized in the treatment of substance addiction, alcohol abuse in that field, and you are in Stanford psychiatry department. So I'm curious, do you want to share with our audience what got you interested in the field?

Unknown Speaker  2:30  

So I think from the very beginning, I got interested in general psychology and after I did some research in addiction, I found this field is just so fascinating. There's no cure so far, and there is more research needed. So that's the part most attractive to me. I say

Unknown Speaker  2:54  

yes. Regarding the no cure, it is sometime for the addiction field. It's difficult to find a way to really say I can totally make you recover 100%, right?

Unknown Speaker  3:08  

Yes, a lot of times I share with my patient because a lot of patients come to me was a lot of shame, a lot of guilt. I always tell them and I share my philosophy, wisdom is that relapse is part of the recovery. And I will like to help you on that past. relapse is part of recovery. I really like that.

Unknown Speaker  3:35  

So today I know you're really good at doing research on cannabis CBD Vep all these topics. So regarding that I only have limited knowledge in that field. I heard so many different words. Like often we talk about marijuana. We talk about CBD, Cannabis, are they the same thing or they are actually different?

Unknown Speaker  4:00  

I know they are so confusing, right? Right. So marijuana is basically the herbal cannabis which is in contrast to the chemical component of cannabis which is called cannabinoid. So marijuana is the plant and chemical is called cannabinoid on THC is the primary cannabinoid in the cannabis in the plant. So which is the psychoactive component of cannabis. Sometimes we refer it as the bad cannabinoid, and in can contrast it to that CBD is sometimes referred as the goobric cannabinoid. It is the primary non psychoactive component of cannabis. Okay,

Unknown Speaker  4:51  

so there are plans, there are chemicals and there are good and bad ones. Yes. Wow. Okay. So all these different words and Actually they are representing different components of the same like a big branch basically.

Unknown Speaker  5:07  

Yes. Okay.

Unknown Speaker  5:09  

Yeah. So for cannabis in general, if I just use a cannabis, this words to refer this whole branch, I know in medical field in the field, what you are working in, a lot of doctors are using it to help patient in a way right as also is legalized. Marijuana is legalized in California right now. So please plan your field in the medical field. How doctors use cannabis to help patients

Unknown Speaker  5:38  

so they are actually only three FDA approved medications in the United States. They are useful for refractory nausea and vomiting on Raxiom and caxias related to AIDS and cancer and there are two forms of epilepsy. disorders can be treated by one of the FDA approved medications. The most commonly treated condition by doctors with cannabis is actually pain. So this product medication called Sativex, which is available in Canada, but it's not actually approved in the United States that medication is used to full pain they did to multiple sclerosis and cancer. Of course, besides FDA approved medication doctors use off label use medication or products in the United States. They are nearly 10% of cannabis users report using it for medicine purposes. So I would like to cite recently published a paper which is medical use of cannabis in 2019. published in JAMA summarize this in sufficient evidence exists for the use of medical cannabis foremost the conditions for which is use is advocated. Physicians may be appropriately reticent to recommend medical cannabis for their patients because of the limited scientific evidence supporting its use or because cannabis remains illegal in federal law. Okay,

Unknown Speaker  7:33  

so sounds like cannabis can be used in treating certain type of medical conditions. You mentioned treating pain I know that possibly whilst the most common usage of cannabis or marijuana, not only medical field but also for the general public, a lot of patients. They may just go to buy marijuana or something to eat. or smoke to help them numb themselves to feel less pain. I also know some new patient may use CBD oil to help them to sleep. In your opinion, is that really helpful to use CBD or marijuana to help to manage either pain or insomnia or even anxiety?

Unknown Speaker  8:23  

Yeah, so CBD is gaining a lot of awareness now it is fund is not addictive, which is great compared to the THC which is actually addictive. So CBD can be useful for conditions such as anxiety, insomnia, chronic pain, but they are a few caveats I would like to point out, it is very difficult to dose because so far we do not have a golden standard of dozing and a lot of times Commonly mixed with THC. So be aware that currently CBD products are not FDA regulated is actually monitored by department of agriculture. So, whatever is on the label may not be as accurate as pharmaceutical company need FDA approved medications and they are side effects related to CBD to for example, I mentioned earlier this medication epidemic lacks specifically made for two real forms of epilepsy, the side effects for example, insomnia is actually up to 11%. So those are a few things we would like to keep in mind. And then lastly, if you are taking other medications, CBD maybe have some interaction with the medications. So you You may want to talk with your doctors. Or Alyssa Tell your doctor you're also taking CBD products.

Unknown Speaker  10:07  

Always good to know that actually CBD if it's pure CBD is not addictive THC is right. Yeah, yeah, I remember why workings of substance abuse like psychological treatment center before the test target on the THC component. Yeah, so but sounds like it's really hard to tell them apart. There's no so called pure CBD on the market.

Unknown Speaker  10:35  

Public views. Right, right. The probably the most, the purest of productive so far in the market is the FDA approved medication abogado labs for the two rare forms of epilepsy.

Unknown Speaker  10:49  

But that's the medication you mentioned. Insomnia actually could be one of the side

Unknown Speaker  10:54  

effects. Yes, it Yeah, and not to eat them percent. That's a big

Unknown Speaker  10:58  

proportion of the patients right. Ray, it can possibly like trigger some people's symptoms of insomnia. Right. Interesting. Yeah. And also when we treat insomnia, I think we talked about for marijuana use it actually does something to disrupt our sleep quality. Mm hmm. Yeah. Okay. Anything else you think the audience you really want the audience know about CBD usage.

Unknown Speaker  11:25  

The bottom line is do not smoke on me. So because they are a lot of CBD oil actually used by vaping right. So because there are a lot of side effects related to labeling. So the first one is you would be depending on the vaping products you use. You wouldn't be exposed to nicotine or THC or the mext of nicotine entity to see and they are leaping components. Produced by the devices the way pain, right? And they are also risks of the actual devices.

Unknown Speaker  12:09  

Okay, so just don't do that.

Unknown Speaker  12:12  

So the bottom line is if you want use cannabis CBD products do not smoke Do not wait.

Unknown Speaker  12:21  

Hmm. And what's the better way to eat it?

Unknown Speaker  12:25  

Yes. So animals, for example from harm reduction perspective is less harmful. Oh, okay,

Unknown Speaker  12:33  

that's good to know. Okay. So bottom line is no smoking, no vaping Yes. Just be careful how you use it. Okay, great. So, since we are talking about whipping, I know a lot of young people nowadays are really into it like the electronic cigarette all that so can you please his plan this word weeping what is weeping Exactly.

Unknown Speaker  12:57  

So making basically To us and E cigarettes product is commonly called whipping. As I mentioned vaping products can be the mixture of CBD or THC and CBD and THC So, and also nicotine can be mixed with that too. So those three components may be in the making products, CBD THC, nicotine,

Unknown Speaker  13:27  

hmm, all all things that mixed together could be quite harmful to our health and sounds like it's hard for us to know what's exactly in the product, what's the percentage of each component. CBD products are not regulated by FDA. The E cigarettes is actually regulated by FDA. Okay, so they may be some overlapping gray area. I see if that makes any sense or So the regulation is slightly different. I know we have a lot of young audience actually listening to this podcast. So I want to use this chance to really learn from you, the vaping the e cigarette usage, and the pros and the cons from professionals from the medical research that has been established or what we are knowing about it.

Unknown Speaker  14:24  

Are you talking about for all adults or for young adults or for different age groups?

Unknown Speaker  14:30  

Good question. Yeah. So is there any difference? What about pros and cons for young adults for example.

Unknown Speaker  14:37  

So for as I mentioned, the potential adverse effect of e cig, including the exposure to nicotine THC, those are addictive components, and they are vaping components produced by the devices may be harmful. For example, there is a recent epidemic of a valley which is short for e cigarette or leaping product use associated lung injury. So as of November 2019, per the CDC data, they are already 48 deaths have been confirmed in 25 states as of the CDC data, and also they are risks of the actual devices. Okay, so both the product and the device

Unknown Speaker  15:32  

could cause quite a lot of harm.

Unknown Speaker  15:35  

So those adverse effects are harmful to all age groups. But keep in mind, young adults may be more vulnerable to those side effects and others specific concerns in young adults in this specific age group include nicotine dependence, and normalizing smoking behavior which may contributed to Conventional secret use later on. So it could be viewed as a gateway

Unknown Speaker  16:06  

drug. Okay, so even if people use e cigarettes use vaping to in order to stop smoking, the traditional conventional cigarettes, it may actually lead to more

Unknown Speaker  16:22  

usage later. Yeah. So for people who's already addicted to cigarette smoking vaping can be used as a harm reduction method to quit smoking. But for a lot of young people, that may not be the issue. They may not be already addicted to cigarettes to nicotine, a lot of them may be using it out of curiosity, out of peer pressure. They just wanted to try it or to relax themselves or different reasons. So if you're not the super the user already, but using it as a recreation no way so they are paid force to be aware. So it may be okay way to be addicted to nicotine to be addicted to conventional smoking, cigarette smoking.

Unknown Speaker  17:26  

Okay, so when you start using e cigarette a may lead to something more even if you are not addicted from the beginning. Wow, that's good to know. So all this reasons you mentioned I guess that's what makes younger adults or teenagers more vulnerable to the adverse effects of it.

Unknown Speaker  17:45  

Yeah, so the adverse effects are harmful to everybody. And because the young bodies may be more vulnerable to those harmful effects and another thing if they're not already addicted to nicotine, then Maybe a way to be addicted. So instead of people who's already addicted to nicotine trying to use vaping as a way to quit smoking, so kind of your reverse order,

Unknown Speaker  18:14  

right, that's interesting. I never thought about that direction, because I think I hear more the normal way people try to use it to quit smoking. Right? And I was thought about what if you just start using it out of curiosity actually may lead to addiction later? Wow. Okay. Good to know for the younger audience. So I know as healthcare providers, you see a lot of patients I see a lot of patients and the P e cigarette and the CBD, all these topics come up here and there. What are some suggestions or what do you normally tell your patients if they come to you, and somehow leaping right up in the conversation as they asked for

Unknown Speaker  18:57  

your suggestion for leaping Dissolve. The first thing is that it gets your lungs exposed to the harmful components. So the bottom line is do not wait for them to wake right do not smoke Do not wait. They are ways for example, use edibles if you choose to use it for both nicotine or CBD or cannabis,

Unknown Speaker  19:22  

yes, very general in general. Okay. I see. I'm curious any of your patients ever said no to that suggestion?

Unknown Speaker  19:31  

Yes, if they're not ready to change, right, so, a lot of times we use motivational interviewing skills trying to get patients to the test stage.

Unknown Speaker  19:43  

Okay, I guess just bailing out all the pros and cons side effects and how people understand what's behind it. Possibly quite helpful. Yeah, helps them make decisions. Yes. My philosophy is to give them my knowledge And they can make an informed decision. Hmm, that's awesome. I really like that. So eventually you are helping your patient to make their own decision based on all the evidence, all the informations you're not forcing

Unknown Speaker  20:17  

a decision. That won't last long, right? We all know that wouldn't work.

Unknown Speaker  20:23  

Yeah. And also not work at all. Yeah, great. I really liked that. I learned a lot about leaping and CBD, all that from you. So anything else? your bottom line is very clear. And the last thing about vaping you really if there's any you want let the audience know.

Unknown Speaker  20:43  

I want to share that some people are actually more likely to develop a problems when they use cannabis THC CBD products, specifically people with personal or family history of psychosis or substance use problems. So again, if using consider non smoking non vaping methods, if you choose to smoke Canvas, avoid inhaling deeply or holding your breath. And another thing is avoid use daily.

Unknown Speaker  21:20  

Okay, so the method you use it if you have to use it, if you have family history, you want to be more cautious how you use it and how frequently you use it.

Unknown Speaker  21:29  

Yeah, for some of the people, they are just slightly higher risk to develop problems. addiction, maybe part of it. Yeah. Aside from the house, and it was effects we already talked about.

Unknown Speaker  21:45  

Right, right. Yeah, just like many other medical conditions, including sleep disorders, if you have, like certain people are more likely to develop those risks or symptoms. Yes. Great. So before we end because personally I work with a lot of sleep patients, anything you want, talk about anything you want to let the audience know between, you know what we talked about today weeping cannabis, CBD, and asleep.

Unknown Speaker  22:20  

More and more people are gaining awareness and they're trying to get the benefit of using right. So I think those are the things I would recommend you to keep in mind medication interactions, you may want to talk with your physicians, and this is share with your physicians you have been using those products, it's very important. And also even you think is the purest CBT in the market, be sure and actually it's very hard to be sure maybe I haven't had two patients coming to me. They will tell me this is very reliable production. he or she's been using, but then the urine toxicology screen turns out to be THC positive. So that's maybe a way to monitor the products, you can do those tests to really help yourself understand.

Unknown Speaker  23:16  

Yeah, what is really in the product?

Unknown Speaker  23:18  

Yeah, a lot of times the label may not be accurate, right.

Unknown Speaker  23:22  

I remember before when you gave the lecture, you also mentioned some products like hair products and the shower products can even contain some of these components without people being aware.

Unknown Speaker  23:35  

Yeah, that could

Unknown Speaker  23:36  

be okay. Wow. So we have to watch out what we're using. And if we're using wealth, the products for some purpose, we may want to do some tests regularly to check it out. Okay. So excited, a lot of good research, and I'm wondering if the audience wants to learn more or read more about this topic. Is there any more reliable resources they can refer to and they can go to

Unknown Speaker  24:04  

Yes. So I would recommend the website by the United States government is called a drug abuse.gov. And you can search specifically the topic on marijuana. A lot of information, reliable information on our website is supported by igniter. Okay.

Unknown Speaker  24:24  

Yeah. So I will put that website on the show notes. And I will also put the title of the two articles inside to the show notes. So people when they listen to your show, they can also read those information.

Unknown Speaker  24:37  

Yeah. And there's another website I really like it is cannabis and psychosis.ca. C stands for Canada. So this is a website supported by the the schizophrenias Society of Canada. They have a bunch of very relevant information on this website. Very helpful.

Unknown Speaker  24:59  

Okay. Great. You mentioned earlier about the relationship between cannabis and psychosis population with psychosis. Right. Great. That's very helpful. Thank you very much for your time and coming to the show.

Unknown Speaker  25:12  

Thank you for the opportunity.

Unknown Speaker  25:15  

So that's my conversation with Dr. Dumb. I learned a lot from her. How about you, I hope you learned a lot too. So no matter whether you are considering of using these products, or you are using, or your family friends are using, hopefully you learn from what Dr. Shared or recommended. Please get enough full around information before you make your final decisions. As adults, we all want to make our own decisions and take the consequences. Every decision every behavior has a consequence. So that's why we want to be cautious with We make decisions that may impact our health. We want to know enough information and not just blindly jump into it or just trust the advertisement out there. say, Oh, this is helpful. We want no more pictures or wronged before doing it. So that's today's episode. Again, I'm Asian. Thank you very much for listening to this episode of deep into sleep. If you want to know more about our work our show welcome to come to our website deep into sleep.ca Oh, you can find the show notes at deep into sleep.co forward slash episode forward slash zero to two. If you need the treatment for insomnia and you want to try out this evidence based treatment called CBT I which is CBT for insomnia Welcome to my website at Mind Body garden.com to read More about our insomnia treatment group was thank you very much for today's journey and look forward to seeing you next week.

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Dr. Yishan XuCBD, Marijunna, Vaping, cigaret, weedComment