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Hartford HealthCare Podcast
Bridging the generation gap: Episode 2 Marijuana Use with Dr. Godfrey Pearlson
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Welcome to a special 3-part series of Hartford HealthCare's More Life that will focus on how different generations engage on various healthcare topics.
Hosted by Tina Varona, director of Media Relations on the Hartford HealthCare content strategy team, and administrative graduate intern Levell Williams - a health equity scholar at the Brown University School of Public Health in Rhode Island.
The idea behind the series: identify the “generation gap” in various health-related topics while Tina and Levell share their own, unique experiences representing Generation X and Gen Z.
The goal: to “bridge that gap” through a lively discussion with Hartford HealthCare experts to educate audience members of all age groups.
In episode two, Tina and Levell explore the generational use of marijuana – who likes it, and why – medicinal or recreational? Their guest, Dr. Godfrey Pearlson of the Olin Neuropsychiatry Center at the Institute of Living at Hartford Hospital, is also the author of Weed Science, and he has some fascinating insight.
Listen to the other episodes in this series:
Episode 1 with Dr. Laura Saunders
Episode 3 with Keith Grant, APRN
People who used in the 60s were smoking cannabis that had maybe five, seven percent THC in it. If you go into dispensary now, modally cannabis has 25 to 30 percent of THC. And you can buy concentrates like shatters and dabs and waxes that have up to 90% pure THC.
SPEAKER_02Welcome to More Life and a special three-part series that will focus on how members of different generations are engaging about various healthcare topics. Hosting this series is Hartford Healthcare's Tina Verona, Director of Media Relations on the Content Strategy Team, and administrative graduate intern Lavelle Williams, a health equity scholar at the Brown University School of Public Health in Rhode Island. The idea behind this special podcast series is to help identify the generation gap when it comes to various health-related topics. While Tina and Lavelle share their own unique experience representing Generation X and Gen Z. The goal? To bridge that gap through a lively discussion with Hartford Healthcare experts. In episode two, Tina and Lavelle explore the generational youths of marijuana. Who likes it and why? Medicinal or recreational. Their guest, Dr. Godfrey Perlson of the Olin Neuropsychiatry Center at the Institute of Living at Hartford Hospital, is also the author of Weed Science, and he has some fascinating insight. Here's Tina Lavell and Dr. Perlson.
SPEAKER_03Approximately one in ten people who use marijuana will become addicted.
SPEAKER_00And when they start before the age of 18, the rate of addiction rises to one in six. This, according to the Substance Use and Mental Health Services Administration, in July of 2022.
SPEAKER_03So, Lavelle, who is using marijuana and how are they using it? According to Headset, in 2021, Gen Xers, ages 40 to 55, held 23.3% of the cannabis market share.
SPEAKER_00In that same year of 2021, millennials accounted for 51.8% of that market share, with Gen Z coming up rising at 12.7% market share.
SPEAKER_03And that dovetails nicely into a 2021 report out of Forbes that finds first-time cannabis use surging among women and Gen Zers. The study actually showed 50% of new consumers indulging in cannabis five or more days per week. So, Lavelle, why are Gen Zers increasing their first-time use? It's definitely on the rise among your generation.
SPEAKER_00You know, Tina, uh just based on my lived experience, I would say that it's a combination of two things. Uh, one being the trauma that you know young people are facing and not always knowing how to deal with, oftentimes this converges with mental health. And then on the other hand, I would say the accessibility to a variety of kinds of cannabis, and you know, it just makes it sort of an exploratory endeavor. You've got your topicals, your your smoke, your vape, you've got your you know, all the different kinds. Um so I think it's a combination of the things that we are experiencing in terms of trauma and the accessibility to an exploratory experience.
SPEAKER_03You know, if I rewind several years back to when I was your age as a Gen Zer, growing up marijuana was pretty popular in in high school. And a lot of people just smoked marijuana. That's what we did. There wasn't all of the ways or methods that there are today. It seems like there are more. It seems nowadays Gen Xers aren't really on the map, maybe only a small amount with marijuana, and maybe I think the use among my population is more of the medicinal marijuana as opposed to recreational marijuana. But I want to bring in our expert, Dr. Godfrey Perlson. He's the director of the Olin Neuropsychiatry Research Center at the Institute of Living at Hartford Hospital. Dr. Perlson, it's always a pleasure. Thank you for joining us.
SPEAKER_01Uh, Tina, you're more than welcome. I agree with everything that you and Lavelle have said so far. And a couple of points just to underline what you're saying. One is that the other thing, in addition to the factors that Lavelle mentioned that drive use is perception of risk. If people think that a product will be harmful, then they're much less inclined to use it. If they see it as non-harmful, they're more, conversely, more inclined to use it. And the perception of risk of cannabis has fallen dramatically over the last 20 years. So people see it as a relatively harmless substance, then that includes being safe to use during pregnancy. So perception is one big thing. Second fact is that people over 60, people of in my generation, are also increasingly using cannabis, mainly for medicinal purposes, um, to help both with pain, which is the curse of elderly people, and disrupted sleep, which is the other curse of older people. So if you talk to dispensary owners, which I do frequently, they'll tell you that there are a number of people aged over 60 who are increasingly asking for cannabis for those purposes. There's no actual difference between medicinal and recreational cannabis as such. They're basically the same substance used for different purposes. They're not dramatically different. They're identical, in fact.
SPEAKER_03And I think, Dr. Perlson, I think my generation, the Gen Xers, in between sort of your generation and Lavelle's, I think we're on the transition or on the cusp of that. I think some of us are using it for recreational, but some of us are using it more for medicinal. I think now in my age group, would would you agree with that?
SPEAKER_01Yeah, Tina, I would agree with that. The other thing that's changed between all of our different generations is the percentage of THC, the um psychoactive, main psychoactive substance in cannabis, has increased dramatically so that people who used in the 60s were smoking cannabis that had maybe 5-7% THC in it. If you go into dispensary now, modally cannabis has 25 to 30% of THC. And you can buy concentrates like shatters and dabs and waxes that have up to 90% pure THC. And people who use concentrates, just back to Lavelle's initial point, much more likely to develop cannabis use disorder.
SPEAKER_03And let's talk about that, Lavelle. What are you seeing among your generation in in terms of what Dr. Pearlson is saying about cannabis use disorder?
SPEAKER_00I definitely think that what you were saying about presence of THC is ringing true because you know, when we talk about cannabis as a product, we we have to look at the many different containers. Uh one of the most popular kinds of you know containers is vaping right now. And there's a lot of questions around it, but one of the things that is consistent is that many times young people don't know exactly what they're smoking or what they're eating or you know, what they actually have. They got it from a a person, whoever the person may be. Um, and this actually gets into what we'll begin to talk about the differences between illicit cannabis use and non-illicit, you know, uh legalized. So I think that is a through line with Gen Zers using cannabis. They're oftentimes not aware of the risks because they're not even aware of the levels of THC. What's the difference between low and high? And you know, where are those uh levels at based on the product that they are using? Um, Dr. Perlson, does any of that ring true to you?
SPEAKER_01Yes, absolutely. Because THC is still illegal at a federal level, there is a complete lack of uniform controls over products. So labeling is not centrally controlled, it's often highly inaccurate. And as you say, when purchases are made illicitly, who who knows what the heck is in there? So labeling may be completely inaccurate or just or just missing. Because states have got greedy and used tax on cannabis to cover tax shortfalls, often products are overpriced. And overpriced products just drive everyone back to the illegal market where it's easier to and cheaper to purchase.
SPEAKER_03Yeah, I was gonna ask you on the flip side of that, with the recent legalization of recreational marijuana here in Connecticut, how has that impacted from a generational standpoint in terms of, you know, now that it's readily available, easily accessible, you can go almost anywhere and get it. Who's using it?
SPEAKER_01Although from a legal point of view, can recreational cannabis is available in Connecticut, dispensaries don't yet stock it. So this is something that will happen in the near future, but to my knowledge, hasn't happened yet. So people purchase who who want recreational cannabis, either buy it on the black market or get it from adjoining states like Massachusetts and just go over the border. So one thing with pricing is that it has to make sense on a regional level, not just within states. Usually what happens uh when states legalize and cannabis finally becomes available recreationally, is that more and more people use.
SPEAKER_00On that note, Dr. Perlson, you've alluded to a little bit of the dynamics of pricing. Uh, can you speak to the weight that policymaking has, not only on the question of whether or not the cannabis use is legal, but on the question of whether or not it's practically something that people can engage in based on how it has been legalized in terms of pricing and availability.
SPEAKER_01Yeah, Lavelle, that's a really um fascinating topic. So I I guess the the best touchstone for that is what happens with alcohol. For example, in Scotland, there are very high rates of alcoholism. And partly what was driving that is you could go into a supermarket and buy very large, like several liter bottles of alcohol incredibly cheaply. So what they did is just increase the task, the tax on alcohol and made it more expensive to purchase. And that that profoundly lowered local alcoholism rates. So that many economists think that there's a price point for cannabis, that above a certain amount per gram, people think it's really cheap and buy it and use it a lot. Whereas below that critical price point, people are see it as a luxury, like cigarettes, for example, and are less inclined to buy it. The other thing is that different states tax cannabis based on completely different principles. So some tax it based on weight and others on THC content. So if it's taxed on weight, uh it's a better bargain to go into a dispensary and buy 90% pure THC, and then that becomes more risky. Whereas if it's taxed on the basis of THC content, everything's on the level playing field and that doesn't happen.
SPEAKER_03You know, Dr. Perlson, uh, at the Olin Neuropsychiatry Center, you've long conducted many investigations into marijuana's effects on the brain. It's been studies ongoing for years at the Olin Neuropsychiatry Research Center and how marijuana impacts the brain. And I know it's it's fascinating because you talk about schizophrenia, IQ deficiencies, but now that we're seeing nowadays the THC content, the rise in that compared to generations past where it was a much lower percentage of THC content. Let's talk about that increase of THC content and how it is impacting the brain. Talk to us a little bit more about your studies and also the statistics that show that cannabis use is on the rise among the Gen Z population.
SPEAKER_01Right. So the cannabis that we use in our research is supplied by the federal government. And the highest percentage that they provide is 15%, which people sneer at as being low quality. And absolutely nobody is doing research on concentrates, and they're not provided by the government for research purposes. So there's a huge gap in the literature and a gap in what researchers are able to access to address those questions. But all of the research that we do, we use a very low percentage of THC cannabis, so half a gram of about 6%, as well as a higher level of cannabis, which actually does get people intoxicated, so half a gram of 15% THC. So all of our driving experiments and our effects, looking at what happens to the brain when people are driving in virtual reality inside an MRI scanner intoxicated on cannabis, are done using that design, as is our virtual driving for roadside sobriety testing for the National Highway and Traffic Safety Administration. We're also trying to look at effects of cannabis on aging. So that's an incredibly understudied area. All these people over 60 who are using, we don't know if for pharmacokinetics, the way the body breaks down cannabis and circulates it is different in that population, or if it has different cognitive effects. And we're looking at CBD as a therapy for people with schizophrenia based on their biological typology. And we're also looking at terpenes, which are compounds inside of marijuana that give it its flavor and odor, because some of them have potentially therapeutic effects. So we're looking for effects of terpenes on pain and effects of THC and CBD on migraine. Although all of that, those last three subjects are things that we're just beginning to look at. We don't have any data on that at the moment.
SPEAKER_00You know, you touched on the gaps in the data and the gaps in the research. Given those gaps, what have we learned about, especially among Gen Z, uh of which I'm a member, about the effects of this uptake of cannabis use on the brain, uh, especially considering the fact that we're at risk because we don't often recognize the potential harms. Is there anything that the research has uh yielded about its effects on the brains?
SPEAKER_01Yes, many um many areas are still highly disputed. But most people would now accept that teens who use large amounts of cannabis from their teens on, particularly with high THC content, are more at risk for psychotic illnesses, including schizophrenia. Effects on IQ are much more disputed. A lot of the early evidence has now been undermined, so that when we look at the siblings of people who use marijuana but themselves didn't use. So, like, for example, let's say I'm a 17-year-old who's using marijuana every day, but my 16-year-old sister isn't, then the so-called effects on IQ lowering affect both siblings equally. So it seems to be driven by things in the environment other than cannabis use. And the early scare stories that cannabis lowers IQ seem to have been discounted, particularly through careful twin studies that have been done at the University of Iowa and elsewhere. So the effects on psychosis risk seem real. The effects on IQ are very much disputed. And the effects on chronic use, like what happens to people in my generation who used cannabis in their 20s and 30s and then stopped, uh, are they more at risk for brain illnesses as they get older? Are they more at risk for dementia? There are tiny studies that show that their hippocampuses are smaller, and that that's a risk factor for Alzheimer's disease. But that is a complete lack of epidemiologic studies to answer that question. Yeah, a small number of things are known, a much larger thing, number of things are really unknown and a potential fodder for important research.
SPEAKER_03Dr. Perlson, when you talk about the study and the impacts on the brain in terms of increasing um schizophrenia, possible IQ deficiencies, what happens in the brain? Is it the THC? What happens in the brain to cause schizophrenia from marijuana use?
SPEAKER_01The real answer to that is no one knows. There is this um long-standing hypothesis that psychotic illnesses in part are due to abnormalities in dopamine receptors and the amount of available dopamine that's available in nerve cells in the brain, and its relationship to NMDA and methyl diasparate, which is an excitatory brain neurotransmitter. And uh a group of people in England using PET scanning, positron emission tomography, where you give people small amounts of a radioactively labeled chemical and use a special camera to quantify or try to show that giving people THC will either release more dopamine as a result or alter the balance between dopamine and glutamate, which is the substance that binds to these NMDA receptors. And the evidence on all of that is sort of mixed and murky. It's sort of a beautiful hypothesis without a lot of supporting evidence at this point. So people have done very careful PET studies. And the bottom line is gee, kind of that's interesting, but we can't reach any firm conclusions. But that's the leading idea of what might be going on. Um but there's very little actual evidence for that at the moment.
SPEAKER_03And the increase in in terms of the Gen Z population using or turning to cannabis, first-time usage, should that generation be concerned or should we be concerned that marijuana could lead to other types of illicit drugs, or oftentimes we hear of designer drugs, the MDMA. When I was growing up, you really didn't have those types of designer drugs. But today with fentanyl, there's there's just so much out there. Can that lead to a shift? Can this marijuana use be a catalyst to other types of drugs among this generation?
SPEAKER_01Yeah, so the I I guess what you're alluding to is an updated version of the gateway hypothesis. And although there's a little bit of evidence that cannabis may lead in some people to use of other drugs, that effect doesn't seem very strong. It's equally strong for tobacco, for example. The the real people who are at risk, just to look at a slightly different facet of that question, seem to be sort of teens, particularly teens who are using large amounts of high THC concentrations, because their brains are still developing. The endogenous cannabinoid system that we have in our brain sculpts brain development. So basically, using THC is interfering with those processes. And that they don't become fully completed until people are in their mid-twenties. So there's a lot of argument for using people age 21 and under not using cannabis. The other at-risk population is probably pregnant women, just because the fetal brain uses the endogenous cannabinoid system to sculpt the fetal brain and its development. And because cannabinoids are fat-soluble and cross the placenta, pregnant women really shouldn't be using uh cannabis, say, to try and treat symptoms of moon sickness.
SPEAKER_00Definitely some very insightful information, Dr. Parlson. To change gears just slightly, this question of uh, you know, illicit uh versus legalized and the different kinds of cannabis use somewhat comes up against uh some social justice questions. And um, not to get too far into the weeds, but uh in your work, uh where where have you found intersections between the justice system and the information that is, as you mentioned, still in development around what the true effects of cannabis use are? Uh what does this mean for those who have come before who have had their struggles with the justice system in regards to cannabis use? And then how do we justify going forward uh even controlled use? Have any of those questions come into play during your work?
SPEAKER_01Yeah, there are questions that I'm asked about a lot. So uh as everyone's aware, there's a vast disparity in the arrests for possession of small amounts of cannabis among racial minorities and people of color. And that's fed into the prison industrial complex. So, I mean, that there's there are good arguments economically. To indict the prison industrial complex as having sort of grown on the backs of those huge numbers of arrests, those disproportionate arrests of uh of minorities. And that that's something that I'm I'm I'm asked about um in in terms of social policy, in terms of retributive justice. Like when licenses are handed out for dispensaries, then and and their those dispensaries are built in um minority-majority districts, then the the those people who've been arrested and those people who've been involved should be first in line um in terms of uh receiving dispensary licenses. Some states have taken a deliberate effort in that direction, others not so much.
SPEAKER_03I do want to talk about your your book, Weed Science, your first edition, which you take a closer look at the sort of the controversies and challenges surrounding cannabis. What have you learned from that book? What do we know about marijuana and how do we know it?
SPEAKER_01So um the thing that surprised me most was that cannabis has been around for such a long time and has so many uses. So it's been cultivated in China and in the Near East, literally for thousands of years, as a medicine, as an agent for consciousness change, particularly in religious concept contexts, so basically for its psychoactive properties, but also as a food, so that um cannabis seeds, uh hemp seeds are very nutritional. And hemp as a rope, um uh because of its long, tough fibers, has been used in rope making and sail making for years and years. So the word canvas, as in sales, derives from cannabis. So that this is sort of a multi-purpose plant that's been deliberately cultivated by humans and maybe one of the first ever cultivated crops. So that the archaeology around that was like a huge surprise to me. As well as the fact that psychoactive effects and medical effects have been known about for such a long time and investigated for at least a hundred years. So research into various effects of cannabis medicinally and psychoactively has also a very early history.
SPEAKER_00Thank you, Dr. Perlson. You know, that I'm a little bit of a history buff myself and especially linguistics. I heard you mention the uh etymology of uh cannabis. That's very interesting information. Uh, you know, we've spoken a lot about some of these great big statistics and these great big ideas, but if we can bring it uh in our closing down to the person-to-person, very practical level. Um, I being a member of Gen Z, Tina of Gen X, what is it that any given person, no matter the age, what is something that you would say to anybody about the standing of cannabis use right now in regards to the fact that we're coming through quite a transition, coming from a stage where you know it was don't do drugs to frankly uh a war of some saying do drugs, like you know, very much enjoy it, and others disagreeing with that opinion. How can we find the safest way forward uh without finding ourselves in a rhythm?
SPEAKER_01Yeah, LaPelle, that's a that's a great question. I I think the if if we take a sort of middle path on that and say that cannabis or THC is a drug, that all drugs have harms, all recreational drugs have harms, so what what is the harm level of cannabis use compared to alcohol use or tobacco use are currently illegal drugs. Seen in that light, with sort of taking all the hype away from it, saying cannabis is natural and it's an herb, therefore it must be harmless, which is ridiculous. But just saying cannabis has pleasant effects, which is why so many people use it, and medicinal effects, which is why so many people use it. But like all drugs, it has side effects and harms, and we need to be aware of those. But in terms of the level of those harms, it's them at a much lower level than alcohol, for example. Alcohol is a very harmful drug that is very socially disruptive and leads to intimate part of partner violence, for example, to which it's very closely linked, and in a way that cannabis is not. So it isn't that cannabis is harmless, it's just that, relatively speaking, compared to alcohol and tobacco, it's a much less harmful drug. And for people who use it recreationally or medicinally, they just need to, if they're using it, bear the arms in mind and be aware of them. So, for example, to teens and to pregnant women.
SPEAKER_03Very interesting. And I think um, at least for among my generation, I oftentimes hear of friends of mine, if you have an ache or a pain or something, they'll say, Oh, just get some CBD oil. It's perfectly fine. So there's that aspect of it too. Um, what are your thoughts on the whole CBD oil sort of craze that's out there?
SPEAKER_01I I think there's an enormous amount of high potential then. First of all, the actual amount of CBD in most CBD products, from oils to tinctures to edibles, we didn't talk much about edibles, is incredibly low. Probably so little that it couldn't have any therapeutic effect. And most of the research to look at effects of CBD oil or other other forms of dosing in a double-blind crossover uh randomized trial have not been done. So we're we're really not sure what CBD oil actually helps. And third of all, a lot of the preparations don't necessarily get into your body in particularly high concentrations because of the formulation of the delivery vehicle. So if you rub THC oil on your skin, how much of that is actually penetrating into your sore knee or wherever you're rubbing it? People are not very clear about that either. So for all those reasons, a lot a lot of CBD research is still kind of wide open and we really don't know the facts.
SPEAKER_03And just in closing, Dr. Pearlson, final thoughts in terms of marijuana usage going forward. What does the future hold in terms of generations? What do you expect to see? Do you expect to see this rise continue among Gen Zers? What does the future hold? And also, do we expect a second edition of Weed Science from you?
SPEAKER_01So, um, yeah, to answer the second question, uh Elsevier Academic Press that published Weed Science priced it, although it's a popular science book and it's supposed to have a popular science audience. They priced it as if it were a textbook at around 100 bucks. So if you go into Amazon and you want to purchase Wheat Science, it's like $95. So if we ever wanted to sell in a second edition, it should be priced reasonably at around $25 to $30. Hopefully, a second edition will do that. As far as use by Gen Zers, we should look to Canada as to what happens when cannabis is legalized at a federal level, which is yes, there have been marked increases in all age groups as a result. But that if you take precautions like not having huge billboards for dispensaries right next to a school, or having uh Joe Camel-type packaging to make cannabis products extra exciting to teens and people in their early 20s, then you can definitely have an effect on sales, includable social policies that should be adapted in the U.S.
SPEAKER_03Dr. Godfrey Perlson, director of the Olin Neuropsychiatry Research Center at the Institute of Living at Hartford Hospital. It's always a pleasure. Thank you for your time, for your expertise. Uh, we talked a lot of a lot of issues among the the two generations here, so we appreciate your time.
SPEAKER_01Tina and Lavelle, thank you so much. It was a pleasure.
SPEAKER_02Thank you. Tina, Lavelle, and Dr. Perlson. Be sure to check the links in this episode's notes to learn more. And for the links in the other two episodes in this three-part series, bridging the generation gap. Be sure to follow more life to be notified each time a new episode drops. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.