Marijuana Pharmacology - FOAMed Video

Paramedic Resource

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In preparation for the upcoming major decriminalization of marijuana in Canada this year I set about reading everything I could get my hands on to really carve out my understanding of it.

I figured I would share my findings in video form. Would like to know what you think of it and especially if you believe I have erred in any way on my findings. Readings are slim on the subject, and there's a whole lot of quackery to wade through. Here's what I came up with:


What do you figure, did I hit the mark? Do you have additional references to better round out my findings?

Cheers all
 

Peak

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Nice work. Just a couple of thoughts since it has been legal here for quite a bit.

Standard dose should not exceed 10 mg in a single dose, new users should start with 5mg or less. Tourists seem to love to take more than one edible since they don't feel the first one for a good bit, then BAM!!! all at once. Dosing is based on THC and CBD, which as you stated does vary based on different strains and products. High THC/low CBD products are associated with increased anxiety and paranoia, which for some reason pot tourists seem to think they need to start with high THC strains. Strains sold now are much higher in THC than those decades ago.

Large doses can cause respiratory depression, especially so in small children. I have yet to see anyone over the age of 4 get intubated and any adults requiring BiPAP, but we have admitted quite a few cases to the PICU. I have only seen these when kids get into their parents stash, not from any of the parents who give their kids marajuana derived products for seizures or cancer. Typically they return to baseline in 2-3 days.

Immunocompromised patients should never inhale/smoke marajuna, there are fungus strains that can grow out in their lungs (we seem to see this the most with teenage oncology patients). While I would never advocate for using marajuana medically, we do have risk limiting discussions including safety being higher with edibles than smoking in these populations.
 
OP
Paramedic Resource

Paramedic Resource

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Thanks very much for the additional info! I most definately did not run into any readings on the items you mentioned. Really helps round out my understanding of this substance, wish I was able to get all this info before posting the video... all of those point are absolute gold. Especially the pediatric respiratory depression, that’s really interesting, I wonder what the mechanism is

Cheers!
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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I wonder what the mechanism is
I'm wondering what follow up information has come to light since that post. The clinical details, not lamestream media noise. Any links? White papers?
 

ffemt8978

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I'm wondering what follow up information has come to light since that post. The clinical details, not lamestream media noise. Any links? White papers?
Most of the links that have been posted in this thread have been spammers trying to push their CBD products.
 

RedBlanketRunner

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Kevin L

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The only problem that I saw with marijuana when I worked as a medic was (and this is a belief of mine, not something I can present as a fact) were young kids in college binge-drinking and smoking reefer at the same time.

There were many alcohol poisonings, as I believe that marijuana (a potent anti-emetic, which is why it's good for chemo patients) kept them from vomiting, and because they didn't vomit . . . they died, ended up with brain damage, in a coma on a ventilator, and so forth from the alcohol.

This seemed very common on college campuses when kids went "hog wild" after not being under mommy and daddy's control anymore for the first time.

I sent letters with this particular concern about weed to JEMS and a few other places, but they didn't get published.

Please note that I'm not talking about someone who comes home from a stressful day at work and chooses to relax by smoking a joint and having a glass of wine . . . but kids who have to egg each other on to see how much they can drink to prove some imagined point about adulthood and "masculinity."
 
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RedBlanketRunner

Opheophagus Hannah Cuddler
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There were many alcohol poisonings, as I believe that marijuana (a potent anti-emetic, which is why it's good for chemo patients) kept them from vomiting, and because they didn't vomit . . . they died, ended up with brain damage, in a coma on a ventilator, and so forth from the alcohol.
From word go, I'm anti marijuana, along with any other drug that isn't a necessity. That being said, marijuana is getting somewhat of a bad rap in that it's out of the closet so to speak and effects of it combined with alcohol are very well know. We aren't getting anywhere as much info on the effects of alcohol combined with other restricted substances, notably cocaine and methamphetamine which people are far more hesitant to admit to combining with alcohol.

Anyway, just a thought. Public warnings. Like of tobacco products. Legalize marijuana world wide, but firmly affix, sell a warning to go with it, avoid combining this substance with other drugs.
Of course the real life saving warning will never come into being, a label on every container that has alcohol in it: POISON. Consume in moderation. Do not combine with any drug. Rather sad that such a label is completely socially unacceptable, isn't it?
 

Kevin L

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From word go, I'm anti marijuana, along with any other drug that isn't a necessity. That being said, marijuana is getting somewhat of a bad rap in that it's out of the closet so to speak and effects of it combined with alcohol are very well know. We aren't getting anywhere as much info on the effects of alcohol combined with other restricted substances, notably cocaine and methamphetamine which people are far more hesitant to admit to combining with alcohol.

Anyway, just a thought. Public warnings. Like of tobacco products. Legalize marijuana world wide, but firmly affix, sell a warning to go with it, avoid combining this substance with other drugs.
Of course the real life saving warning will never come into being, a label on every container that has alcohol in it: POISON. Consume in moderation. Do not combine with any drug. Rather sad that such a label is completely socially unacceptable, isn't it?
Agree 100%. In my EMS experience, alcohol killed more people that all other drugs (except tobacco) combined.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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At the risk of beating a dead horse here. I'm attempting to be as lucid as possible.

With alcohol, it's multiple factors 1+1+1... Adversely affects fine motor skills + affects judgement = A few million traffic accidents - clinically proven. But there is a third factor. Socially acceptable to the degree that many people are firmly convinced the inebriated condition is a no harm, no foul. Of course the adverse effect on judgement equates to greater risk taking and the denial mentality, 'I only had X therefore I'm legal therefore my condition won't cause problems'. This is a societal norm. Completely incorrect but a given.

So what will happen, is happening, when marijuana becomes socially acceptable and a societal norm? As I mentioned, alluded to, I'm very weak on the pharmacological aspects of drugs inclusive of THC. Is the legalization of marijuana going to create a similar problem to that of alcohol?

From what I and many others have observed, people under the influence of marijuana appear to err on the side of caution which is a plus, the opposite of alcohol effects. And it appears that combining alcohol with marijuana negates the inhibition effect of THC but to what degree?

Be all that as it may, moving marijuana towards the acceptability that alcohol has is in part a mistake. Alcohol should be moved towards the limited and restricted position THC has had over the years. And of course a little common sense is in order. Alcohol abuse is prosecuted, marijuana abuse has been persecuted. A societal knee jerk response to the false and misleading propaganda marijuana has long been subjected to.

I've viewing this all in a slightly larger picture seen in various countries. Alcohol is so accepted being drunk has been used to justify what would normally be considered a serious criminal offenses - causing great bodily harm, involuntary manslaughter etc. But drugs of any kind inclusive of marijuana are subjected to the most extreme of penalties up to and including capital punishment. Extra judicial executions take place all the time.
The world really needs to get a better grip here.


Extreme examples:
* Mae Rim, Thailand, 2003. 14 vehicle chain collision. Over 30 persons taken to the hospital. Cause of accident determined to be the incipient vehicle travelling over 100 kph in a 45 kph zone. Driver excused from liability because he was drunk and couldn't have foreseen the traffic ahead.
* War on Drugs, 2002-3 Thailand. Well over 2000 alleged drug dealers killed. Nearly every day a new picture in the headlines of a suspect body on the ground with a gun next to it.

(Cops are corrupt here? 2016. One half, 600, of people taking the police academy entry exam were caught cheating by independent proctors overseeing the exam.)
 
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RedBlanketRunner

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Cartels aren't exactly known for employing lobbyist.
I'm unsure what exactly that is in reference to. But in the case of much of SE Asia, in Japan - the Yakuza, in China the tongs, in Vietnam, Lao, Cambodia and Thailand, the society elite, all follow the money and all have a very strong influence with politicians or are politicians themselves. Nepotism and cronyism run the shows.
This is the reason why the Chinese government is a small circle running all with an iron fist and corrupt influencers can face capital punishment, sometimes with the flimsiest of evidence. They are fully aware the money tide runs against them.
As far as drugs are concerned, nobody seriously believes there is a concerted effort at the highest levels of governments to eradicate drug trafficking. The oriental take, mindset: Money is money, is 'winning', regardless where it came from. You don't have the violence as seen in Mexico, simply because the drug channels are more sophisticated and the money behind them, one way or another, runs the governments and tells the police and the military when to look the other way.
 

GMCmedic

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I'm unsure what exactly that is in reference to. But in the case of much of SE Asia, in Japan - the Yakuza, in China the tongs, in Vietnam, Lao, Cambodia and Thailand, the society elite, all follow the money and all have a very strong influence with politicians or are politicians themselves. Nepotism and cronyism run the shows.
This is the reason why the Chinese government is a small circle running all with an iron fist and corrupt influencers can face capital punishment, sometimes with the flimsiest of evidence. They are fully aware the money tide runs against them.
As far as drugs are concerned, nobody seriously believes there is a concerted effort at the highest levels of governments to eradicate drug trafficking. The oriental take, mindset: Money is money, is 'winning', regardless where it came from. You don't have the violence as seen in Mexico, simply because the drug channels are more sophisticated and the money behind them, one way or another, runs the governments and tells the police and the military when to look the other way.
You were talking about alcohol being socially acceptable.

Manufacturers pay a lot of money to lobbyist to ensure it is socially acceptable. Mexican cartels just cut peoples heads off, because socially acceptable (and legalized Marijuana) is money out of their pocket.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Manufacturers pay a lot of money to lobbyist to ensure it is socially acceptable.
Just my take. Alcohol is a disease or debility, like other recreational drugs inclusive of junk foods. The games the neurons and blood sugars play. With THC, the jury is out in my case. I have a neurological condition and any hint of a high sends me into a pretty severe malaise that comes close to triggering convulsions. Though my case is, as I understand it, extremely rare, that drug does possess the ability to cause some severe, almost debilitating side effects.
 

Emily Starton

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Just my take. Alcohol is a disease or debility, like other recreational drugs inclusive of junk foods. The games the neurons and blood sugars play. With THC, the jury is out in my case. I have a neurological condition and any hint of a high sends me into a pretty severe malaise that comes close to triggering convulsions. Though my case is, as I understand it, extremely rare, that drug does possess the ability to cause some severe, almost debilitating side effects.
Yup and some people take this as a reason for not getting a vaccine but it can't be helped.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Yup and some people take this as a reason for not getting a vaccine but it can't be helped.
? I understand what you are saying. But, as a rough analogy, comparing THC to a vaccine is a dachshund vs a draft horse. Both are mammals with four legs.
The common denominator seems to be an extreme lack of critical thinking. The reasoning abilities go un-exercised until they become unavailable.
As the saying goes, if you aren't using your ability to undertake critical thinking and reasoning it out for yourself, you are a slave to what other people have told you.
 

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