The Promise and Problems of Cannabis

JULIE FLAHERTY: People are using cannabis and its derivatives as treatments for dozens of different health problems right now, from skin conditions to cancer to anxiety to Alzheimer's disease. How much research has there been, and how conclusive is it at this point that CBD and THC can help with these problems?

 

ERNEST ANEMONE: There has not been a lot of clinical research involving humans. A lot of it has been mammalian research, usually mice, which is very promising. But we're still not at the point right now where a doctor would be able to recommend something as being effective for a lot of conditions, like Alzheimer's, for example. I was just speaking to a neurologist yesterday who works with Alzheimer's patients, and I asked him what his opinion of marijuana was as a therapeutic drug, and he said, "We're at the point right now where if a patient is using it, I won't tell them to stop, but I also wouldn't recommend that they start using it if they're not." And I thought that was a good encapsulation of where we're at right now.

JOHN DE LA PARRA: Yeah. So it varies really, but there hasn't been the ability to study these things in the way that we would normally study any other drug. That's probably the biggest issue.

FLAHERTY: And why hasn't there been?

 

DE LA PARRA: For the most part, it's because of federal prohibition. So the funding mechanisms in the U.S. for any kind of drug run through federal funding. So in order to get anything approved, you have to go through a very set kind of format where you test things in a very particular way. And if you can't get the actual thing that you're testing, so if you can't get cannabis, how do you ever test it? So for a long time, the only place you could ever get cannabis is from the University of Mississippi. They grow cannabis for research. But it's very hard to get, and these studies are not funded. We lag behind by at least 50—maybe more—years in research on cannabis, just because it hasn't been able to be studied.

FLAHERTY: Oh, wow. And…

ANEMONE: Countries like Canada and Israel have the jump on us in terms of research. So I think we're going to start seeing a lot of really interesting results in the coming years.

FLAHERTY: I think I read that most of the research has been done on cannabis as a whole with THC and CBD—not so much specifically on the CBD. And yet, there are so many products now with CBD in them. You can buy them online, you can buy them in certain places, and…

DE LA PARRA: Walgreens now.

FLAHERTY: ...even at Walgreens.

ANEMONE: And maybe they have CBD in them.

FLAHERTY: Oh, right. So has the marketing gotten ahead of the research on that, then?

DE LA PARRA: So yes. Partly it's because regulation plays a vital role in making sure that when a marketer makes a claim, that those things are actually there. So remember there's a wider dietary supplement market that looks at anything, like ginkgo biloba, let's say, or ginseng, or any other herbal type supplement you might take. And that's very unregulated in the U.S., so if you buy ginkgo biloba and it doesn't make any specific claims about what chemical is in it, or whatever, so whatever the equivalent to CBD might be, you just have to trust that whatever you read on the Internet, or whatever you read in a book, is actually going to do whatever you think it does. And I would say it's actually very similar to CBD. But CBD, now you're talking about a very purified, specific chemical. So it's the wild west for sure.

ANEMONE: It's also very volatile in the sense that it's sensitive to light and air. And as soon as you open a bottle of CBD water, or whatever it is that's being sold now at gas stations and Walgreens, there's a good chance that none of it might be left by the time you actually drink it.

DE LA PARRA: Even if it had some originally, which you have no proof of that. You just trust, and you don't know if it had heavy metals in it, or other things. Right? So...

FLAHERTY: Which is something the entire supplement industry deals with and…

ANEMONE: That's right.

FLAHERTY: …consumers have to be concerned about. But it seems like CBD is in this really weird—like you mentioned, wild west—kind of place of regulation right now, because even in places where cannabis is legal, and there's been a proliferation of CBD products, it's still technically, according to the FDA, it's still illegal to add CBD to a food. Correct? Because they consider it a pharmaceutical.

DE LA PARRA: That's right.

FLAHERTY: Now why do they consider it a pharmaceutical?

ANEMONE: Because that's how it was first approved. CBD went down the track of being approved as a prescription drug, Epidiolex, to treat epilepsy. So I was just actually saying to our class, "Just imagine if, all of a sudden, Arizona Iced Tea said, 'Arizona Iced Tea, now with Adderall.'" It's silly. People laughed. But that's essentially what's happening now with CBD—putting it in food or drink is putting a prescription drug in food or drink.

FLAHERTY: And some cities and states have cracked down on CBD products. They're being pulled off the shelves in places and restaurants, that, I guess, were putting it in their lattes and cupcakes. They're getting kind of—

DE LA PARRA:  I think that's driven by federal law, right, for the most part?

ANEMONE: Well, there's been some controversy about that, about how much of a role the FDA had in advising local boards of health to crack down. And I think that they have established some connection, some communication, but it's probably for the best.

FLAHERTY: And why is it for the best?

ANEMONE: Because I think consumers deserve to know what they're getting and deserve to know what they're buying. And that involves testing these products for adulterants, heavy metals, pesticides.

DE LA PARRA: Yeah, I mean, think about, we're not talking about a plant that someone grew, right? And that's very different, very different. If I were to cultivate my own cannabis plants, and then I know what I put into it and I know what I get out. But now you're relying—just like any other pharmaceutical or thing that you just buy from the store—you're relying on the marketer in a capitalist system to sell you something that is what it says it is, that maybe has no effect anyway, just depending on what's in there. And so it's a very kind of weird space to be in, so it needs to be regulated. We're not saying cannabis, which is the whole plant. We're saying CBD, which is just the purified compound that takes a lot of chemical steps to actually get purified.

FLAHERTY: So Ernie, you've trained medical students at Tufts, and at other universities, on the intricacies of medical cannabis. So let's talk about safety. Advocates like to point out that no one has died directly from using cannabis. Is that true? Yes?

ANEMONE: Yes.

FLAHERTY: Yes. But that doesn't necessarily mean that there can't be unintended medical consequences or unexpected consequences. Can you talk a little bit about that?

ANEMONE: Sure. One of the things that I talk about with medical students is “When is a substance use a problem?” And with cannabis, that could be a very difficult question to answer. Substance use becomes a problem when the consequences of that use outweigh the benefits. And when a patient with good insight, meaning somebody who can make the connection between what they're doing and what's happening to them, can see that there are unacceptable and unintended consequences. How do you counsel somebody in that position is also a difficult question, because not a lot can be said from a public-health standpoint about cannabis, at least not right now, because the research isn't there.

But there are a few things that can be definitively said. And one of those things is that cannabis is a highly variable drug. So how cannabis affects me can be dramatically different than how it affects you, even if I'm using the same strain as you. And also, how it affects me can change over time, which is something that is also not widely understood. So I think that starting from that standpoint of helping people understand that this is, as John has said, it's a complex plant that can do complex things, and we ourselves are complex organisms, is probably the best place to start.

FLAHERTY: So, Ernie, you spent over a decade as a criminal defense attorney and public defender. So you know it's well accepted that cannabis laws have disproportionately harmed people of color. The ACLU and others have reported that African Americans are arrested for cannabis crimes four times more often than white people, despite similar usage rates. But you say cannabis and discrimination have actually been linked for centuries. Is that true?

ANEMONE: Oh, absolutely. The plant has been racialized from the very beginning, all the way going back to its original taxonomy, meaning how it was categorized. The low THC-producing plant, which is usually cultivated for its fiber, it was actually incredibly important for the shipping and sailing industries, because canvas was made out of cannabis. That's where the name canvas comes from. It was weather-resistant, salt-resistance, so it was absolutely essential. It was thought by European observers that the high THC, the intoxicating variety, grew in places like the Middle East and Asia because of the predisposition of the people there to want to be intoxicated. Whereas the low-THC variety, the high-fiber variety, was grown in Europe because of their industrious nature. Molecular geneticists have begun to show now that we're really only talking about one species. It's a social construction—the difference between these two plants.

FLAHERTY: And I believe at some point there were hashish parties that people in the upper classes were having, which were considered, oh, fun and trendy and not harmful. And it wasn't until lower classes started using it that it became a bad thing to do. Is that right?

ANEMONE: Oh, yeah. You could buy Indian hemp, as it was called, in the Sears Roebuck catalog, which was fine for white suburban families making a mail order. There was a novel called The Hashish Eater, which kind of sparked the imagination of people around the world, but also here. And they would have these hash parties, where people would eat these cakes, and laugh, and socialize, and it was seen as socially acceptable. It wasn't until people of other cultures and other classes started using it in different, more visible ways that the negative associations began.

FLAHERTY: So, to go along with decriminalization, Massachusetts enacted a law in 2018 that expunged the records of people convicted for cannabis possession. And I understand New Jersey just rejected a legalization bill that would have gone even further to reverse the damage done by the war on drugs. Has the Massachusetts law improved anything for anybody?

ANEMONE: Honestly, I think it's still too early to say. Based on my experience, I have my suspicions that it probably hasn't. I think that it was essential. I think that it certainly didn't hurt, but it probably didn't go far enough.

FLAHERTY: In some places, including here in Massachusetts, there's been a conscious effort to make the business of cannabis inclusive when it comes to who can grow and sell it legally. And I know that in your class you've said that actually several students have said that they're actually interested in getting into the business of cannabis as well. So, what's the reasoning behind the efforts to make it more inclusive? Who can join the party here?

ANEMONE: Well, there's a long history here of oppression. There's really no other way to say it. The war on drugs was a war on people, and particularly and quite intentionally people of color. And the fact that now we can use cannabis as an important therapeutic drug is a testament to the sacrifices that people of color made to preserve it as such. I think that our inclusion policies are forgetting that capital is very important in a capitalist society, and I think that's where we're coming up short is we can talk a very good game about wanting to be inclusive, but we actually have to back that up with the resources that it takes to include people.

FLAHERTY: So let's talk specifically about how these efforts—what they look like, and who they're trying to include, and how they're doing it.

ANEMONE: Well, our social equity program in Massachusetts, like social equity programs elsewhere, is trying to look at communities that have been impacted by the war on drugs, not only the individuals, but the communities as well. There is a sense, an affirmative action, when it comes to licensing. Somerville has agreed on probably one of the best and most inclusive social equity programs, in terms of there needing to be one-to-one licenses. There are a lot—

FLAHERTY: One-to-one?

ANEMONE: Meaning that, sorry, meaning that a minority-owned business would need to be included one-to-one with a non-minority-owned business.

FLAHERTY: Okay.

ANEMONE: So I think that there are also other strategies that can be used, just in terms of bringing in the right stakeholders, and asking first and foremost from the community what they need the most, as opposed to just sitting on Beacon Hill, so to speak, contemplating what it might be.

FLAHERTY: And you mentioned capital, and I believe what you might be talking about there is just getting the funding to start a business is not as easy as you might think in this realm, because banks still consider funding cannabis businesses an illegal activity in some regards. So, what's going on with those laws?

ANEMONE: Well, banks right now are able to do some business with the cannabis industry, but they have to report on it as if it's racketeering. Essentially, they do. They have to file a report with the federal government, a very detailed report, that they suspect that the client is involved in illegal activity, which puts everybody in a very tenuous position. There are bills right now making their way to the House floor that are going to correct that problem. But, as of right now, yeah, it's very difficult for somebody looking to get into the industry to get a line of credit, which means that venture capital is really controlling the game right now.

FLAHERTY: So wealthy people, who were perhaps involved in the business already, or have money from other sources, could corner the market before others can get in there.

ANEMONE: Yeah. Correct, and they already have, even here in Massachusetts, which has some of, I think, the strictest policies regarding license limits. People have already begun flouting those license limits, and publicly bragging about them. There was just an article in the Globe, too, about some of our businesspeople here who—there's a limit of three dispensaries, but through shell corporations, essentially, they've been able to open up more.

FLAHERTY: So even though it's legal now, it's still not a level playing field necessarily, unless we make it so.

ANEMONE: No. It's far from it.

DE LA PARRA: And we've already seen a brand, like Constellation Brands, a big alcohol producer, has now bought a bunch of interest in Canadian cannabis industry.

ANEMONE: Canopy. Yeah.

DE LA PARRA: Yeah.

FLAHERTY: So, I understand your class on cannabis actually grew out of a class that you taught on medicinal plants.

ANEMONE: Both of us feel like cannabis is an entry point to talk about herbal medicine generally. So there always is this focus on cannabis—we should remind people that the cannabis course started from our medicinal plants course. It just so happened that the plant that we got the most questions about was cannabis. So, we figured why not develop a course where we can talk about it in full? But really, this is about herbal medicine, which is people's medicine, which is a redefinition of medicine, what it means to be sick and what it means to be well. These are the questions that we have to answer because I think that these are the reasons we struggle so much with plants like cannabis, drugs like cannabis.

DE LA PARRA: One of the first things we always do when we give lectures or give talks is we ask the audience to define medicine, because that's a very complex thing to first understand. And then you start—it deconstructs people's conception of what it is to be healed, what it is to be sick, and what it means for the Western concept of what medicine is, like I mentioned before, this reductionist idea that it's one molecule that does one mechanism. But humans have used plants to heal themselves since there have been humans and plants. And really, we're recalling that and coming back to it. Eighty percent of the world's population relies on plant-based medicine in some form of their primary healthcare. So, this is a worldwide—this is a human issue.

And now in the U.S., it seems novel, or—like, I came from a chemistry department, and speaking about herbal medicine often made me a bit of a pariah, like, "What are you talking about?" Most people are mixing clear liquids together all day to make a drug, but I'm going into the woods, speaking to people that are close to survival, close to the plants themselves, and they are saying, "This is what we use to survive." And then you bring that back and you try to understand, "Well, how can we improve those things? How can we learn from those things, and how can we enrich the human experience for the better of everyone?"

ANEMONE: Yeah. The dichotomy is a false dichotomy between Western medicine and indigenous, or folk medicine. Both of these methods can, and should, communicate with one another.

DE LA PARRA: And cannabis is just—it's really great as an example of this, because there are so many issues that are bound into cannabis, from the racialization and the war on drugs, to the scientific aspects. All these things can play roles in any indigenous medicine, in any plant-based medicine. So, we see it as kind of the tip of the arrow to speak about all types of medicinal plants, improve healthcare everywhere.

FLAHERTY: Well, John de la Parra and Ernest Anemone, thank you very much for talking with us today.

ANEMONE: Thank you for having us.

DE LA PARRA: Thanks.

HOST:  Thanks for listening to this episode of Tell Me More. Please subscribe and rate and review us wherever you get your podcasts—and to be the first to hear about new episodes, please follow Tufts University on Twitter, Facebook, and Instagram. We’d also welcome your thoughts on the series. You can reach us at tellmemore@tufts.edu. Tell Me More is produced by Steffan Hacker, Anna Miller, Dave Nuscher, and Katie McLeod Strollo. This episode was edited by Anna Miller. Julie Flaherty wrote the introduction to the episode. Web production and editing support provided by Taylor McNeil. Special thanks to Amy Goldstein and the Experimental College at Tufts, and the Voices from the Edge lecture series, made possible by the generosity of Sarah and Tom Janover. Our theme music is sourced from De Wolfe Music. And my name is Patrick Collins. Until next time—be well.

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“The Complexities of Cannabis”

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