Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
Don't forget to send your questions to Dr. Brian Schmutzler on social media and his website at www.drbrianschmutzler.com.
Going Under: Anesthesia Answered with Dr. Brian Schmutzler
High Alert: How Marijuana Impacts Anesthesia
Marijuana's impact on anesthesia presents significant medical concerns. Dr. Brian Schmutzler and Vahid Sadrzadeh dive into the science behind cannabis and how it affects surgical outcomes and anesthesia effectiveness.
Have a question for Dr. Brian Schmutzler?
Submit them to any of the social media pages below or on his website at https://www.drbrianschmutzler.com/
Facebook: https://www.facebook.com/drbrianschmutzler
Instagram: https://www.instagram.com/drbrianschmutzler
TikTok: https://www.tiktok.com/@drbrianschmutzler?lang=en
Provider or Medical Student?? Subscribe to his Patreon Page to get exclusive content and access to Medical Blocks:
https://www.patreon.com/user?u=89356957&utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=creatorshare_creator&utm_content=join_link
Thanks to our show sponsor: Butterfly Network
https://store.butterflynetwork.com/us/en/?rsCode=BRIAN25
This is Going Under Anesthesia, answered with Dr Brian Schmutzler. I am Vahid Sadarzadeh and we are brought to you, as always, by the Butterfly Network, and they are not calling right now.
Speaker 2:Not yet anyway, All right, I'm going to let you in on something that's completely changed the way that I practice. I've been using Butterfly Probes for years. It's a portable ultrasound that plugs right into my handheld device, my cell phone or my tablet. If you've used older versions, or even if you're new to the handheld ultrasound, let me tell you why the new IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster, whether it's vascular access, procedural guidance or just getting real-time insights from my patients.
Speaker 2:And the tech inside this little device is pretty incredible. Biplane imaging lets me look at short axis and long axis views at the same time. Huge for procedural guidance and, honestly, a great tool for learners. The new needle out of plane preset even shifts the scan digitally, so I can see the needle tip sooner, which makes a real difference when precision matters and the image quality. Honestly, the iq3 holds up to the larger cart based systems that I've used. That's impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the butterfly iq3 enough, and right now they're running a special offer. You can get 750 off the latest iq3.
Speaker 1:Check it out at butterfly networkcom all right, so today, hold up, I'm gonna do. We're gonna have a little quiz here, but don't, don't answer until the end. Okay, all right don't answer until the end, all right. Today we're talking about grass, ganja, mary Jane, reefer, herb dope, chronic gas I guess is the current term zaza, zaza, okay, boof, all right, buds hash blunt, otherwise known as pot weed, and THC. Marijuana, marijuana, yep, Hot weed. And marijuana.
Speaker 1:Today we're talking about marijuana and its effects, negative effects on the brain and the system and your body in general, and anesthesia.
Speaker 1:So I guess the first thing to talk about is how popularized marijuana has become in the united states, and and the not only the popularization of it but the legalization of marijuana as well. First maybe speak to that. So, so just the legalization of it. And you know, is it because of where we are with alcohol in the United States, and you know, I mean again, that's been legalized for centuries. Well, 100 years, 100 years, but like, yeah, not legal for centuries, but still people using it for centuries. But you know why was it that the government decided, yeah, this is the time that we're going to legalize this.
Speaker 2:So, first of all, the active ingredient in marijuana is THC, so we'll talk about THC as we go through the process of talking about marijuana in general. Yeah, so I mean I think Colorado was the first state to legalize it. That had to be probably early 2000s, and then several states have done it, since Several states have medical marijuana and then several have recreational marijuana use as legal Federally, though it's still a crime, and so I mean we can go all the way back to like the 1960s and 70s and the war on drugs, and you know, you can, you can argue whether that was smart or not, I guess overall. So just to talk about marijuana, you know it's.
Speaker 2:It's illegal, federally Correct and legal in some states. So, technically, if you carry marijuana across state lines illegally, that's a crime. On a plane, on a plane, also illegal. Illegal, um, you know, and and several states have decriminalized it. So not making it legal, but also not really prosecuting anybody for it. So there's that as well. Um, you know, I think when we were growing up it was still fairly illicit. People weren't using it. Um, I think people now there's a lot more people now that use not only marijuana, smoke marijuana, but also take the gummies and not just the CBD gummies, the THC gummies as well.
Speaker 1:Well, the engineering and the farming of it have become so prevalent too.
Speaker 2:So which apparently makes it much stronger, more, yeah, more intense.
Speaker 1:The strains.
Speaker 2:Right, I mean the strains of marijuana, I think the other thing that you need to think about is just because it's legal in your state doesn't necessarily mean that your employer doesn't care, and we've seen all kinds of things with if you do things, they may be legal, but they may be against the policies of your employer. So let me just walk through. Let me walk through the sort of in general idea of why I think and I'll, I'll, I'll. What is it it called?
Speaker 1:when, you, when, you tell what you're going to talk about before you talk about it like a preview yeah, what?
Speaker 2:no, it's like this. Burying the lead is when you're right, but what? What happens when you're like tell it right anyway, so non-burying the lead.
Speaker 1:Yeah, exactly. So wait before you do that, though before you do that quickly. I don't know if you're going to go into this, so apologies, but talk medically speaking. Why the term medical marijuana? And again, what does the medical community think about that terminology?
Speaker 2:So in the past and we'll get into this more deeply but in the past there had been some thought that marijuana helped with pain, with glaucoma was a big one. Sometimes people get pain in the eye from glaucoma, anxiety, depression, some of this other stuff. So there are some medical, medically approved indications for marijuana, although there's much better things for most of those now. Right, and I think one of the classic things used to be people who were dying of end stage cancer would smoke marijuana to relax and all that sort of stuff. So so All right. So I'm not going to take a moral stance on marijuana on the show. I have my own thoughts on it, but I won't share that. But let me just share in general. Any substance that you use that, any substance that you use that that removes your clarity, I think is something that's probably not great, right?
Speaker 2:so it allows it marijuana if you're intoxicated with marijuana or any other drug for that matter, you don't have the clarity of mind and the ability to spend significant time with your family or doing your job. Let's say or you know creating a business or you know getting good at golf. We both would love to be better at golf.
Speaker 1:Some would argue that would be better for my golf. Yeah, maybe I'm wearing the cog hill. Hey, nice, I love it. Some would argue that to be better for me.
Speaker 2:So I would say in general, using any substance regularly that causes you to be intoxicated is probably not good for you, and you could maybe make the argument that alcohol is the same way, although I think you could go out and have a drink and not be intoxicated.
Speaker 1:Sure.
Speaker 2:And I think there is some to some degree and you and I you and I have had bourbon together before I think there's some degree where you actually enjoy the taste of bourbon Sure.
Speaker 2:I don't know that you have that same enjoyment of taste of marijuana. Maybe the gummies, I don't know. So I think there's a significant difference between marijuana and alcohol. I would say the primary difference is the whole point of smoking marijuana is to get. Smoking marijuana is to get high, is to have a change, is to feel the effects. Correct Alcohol I think you can make the argument that some people can drink a small amount of alcohol and not have any physical effect from the alcohol.
Speaker 2:So that's the primer. I guess what I would say then is there are a lot of physiologic effects of marijuana, just in general. Okay, so the biggest thing we're seeing right now with the legalization of marijuana is people coming into the ER with intractable vomiting. People who smoke a lot of marijuana get very, very sick and they'll come in with intractable vomiting, meaning that they're throwing up and throwing up, and throwing up and throwing up. And there's something about one of the receptors and I can't remember if it's a cannabinoid receptor or a THC receptor, but in the gut that if you smoke a lot of marijuana, it activates it too much and you just have vomiting. And even when you stop smoking the marijuana, you still have vomiting. So that is a huge thing that we're seeing in the ER, which is a not good side effect of marijuana.
Speaker 2:There's a whole lot of other things. So, and you know, maybe you're old enough and you don't care, but it definitely does reduce your sperm count. So if you're wanting to have kids, smoking significant amounts of marijuana is not good. You know. There's all the cognitive effects, right, and even though it's supposedly not physiologically addictive, it's certainly psychologically addictive. You look at the brains of people who have smoked significant amounts of marijuana and their age more quickly. There's some potential link to Parkinson's disease, alzheimer's, that sort of stuff for people who smoke marijuana, and then, additionally, smoking anything, even though it doesn't have the tar in it that nicotine does, is not good for your lungs. You put any sort of hot smoke into your lungs. It's causing damage. So while the lung cancer rates aren't anywhere near what they are with smoking cigarettes, there are still lung cancer cases that occur from smoking marijuana. There are still lung cancer cases that occur from from smoking marijuana. So all this put together, again, I'm not making a moral judgment, but physiologically and medically it's not a great idea to smoke marijuana.
Speaker 1:My opinion so you know in in terms of again. Um, let's go back to medically speaking. When it comes to medical marijuana, you are treating pain. Yeah, I mean, you're an expert in that area, right? So you studied that you? Did your PhD.
Speaker 2:So the theory behind that is not the THC portion. The THC portion just makes you high, right? The theory behind that is the cannabinoid portion. So so the, the, the molecules in marijuana buying to several different receptors. One set of those receptors are called the cannabinoid receptors. Those are in your brain, those are in your pain neurons, those are all over the place and we actually studied in the lab general labs that I worked in the use of cannabinoids for pain relief and all kinds of stuff. So if you get very specific, you get a molecule that's very specific and very concentrated and you hit those cannabinoid receptors. There is evidence that they prevent pain. The problem is when you smoke marijuana you don't get enough of that cannabinoid to really cause the effect that you, that you're looking for interesting.
Speaker 1:So it's. It's more in the gummies baked goods, food aspect or is it which which?
Speaker 2:so there's some argument that you don't get enough from from the gummies either, because as it goes into your stomach, the acid breakdown, acids break down a lot of that, that, uh, that molecule, a lot of the cannabinoids. So you know, there's work being done to try to create injections and pills and all that sort of stuff that are specific to. I think it it was a CB2, cannabinoid receptor 2, cb2 receptor. That was the most effective.
Speaker 1:So it's infused essentially Either infused or a pill that you can take that, you know, provides that Correct.
Speaker 2:Yeah, it's like a slow release, so it gets through your stomach into your intestine and the acids don't break it down. So, yeah, are there some potentially beneficial effects of some of the molecules within marijuana? Yes, there are. Do I think that justifies medical marijuana? Probably not. Right and there are better medications now and maybe not 50 years ago, but there are better medications now for almost all of the medical marijuana indications.
Speaker 1:Gotcha and taking it a step further now, because we really want to talk about how this has a negative effect on anesthesia. So you know A how do you know that somebody's not high when they come in?
Speaker 2:You don't because there's not a test. There's not an acute intoxication test for marijuana currently.
Speaker 1:Okay, so what I mean? I'm just going to ask you this question because it's just the obvious. Next question how many people do you think have sat on the operating table that maybe you've helped operate on, that have had cannabis in their system, that have had marijuana in their system?
Speaker 2:I mean. So I make the assumption, if they come in smelling of marijuana, that they're smoking it. I don't know.
Speaker 1:30 or 40 maybe in total yeah, not a high number 15 20 000 patients so while that helps the patient him or herself with nerves, maybe, maybe. What does that do for anesthesia?
Speaker 2:What does that do? And again you don't know right, you don't know 100%, Because you could say do you smoke marijuana? Yeah, but I didn't smoke today and there's no way to tell. And you always ask that, right.
Speaker 1:Yeah, yeah.
Speaker 2:Okay, so I don't always ask that, but if I walk in the room, and. I smell marijuana, I ask the question. The preoperative testing clinic will ask that question Do you smoke?
Speaker 1:I don't know, do you smoke marijuana? When's the last?
Speaker 2:time. You had it Exactly, exactly. So I think the consensus guidelines now within the anesthesia community are acutely intoxicated people should not have surgery because they can't consent right, because they're acutely intoxicated. People should not have surgery because they can't consent right Because they're acutely intoxicated. Just like I wouldn't do an elective surgery on somebody who was drunk or clearly high on anything else opioids, whatever so technically, if they're acutely intoxicated, which is hard to tell, they shouldn't have surgery.
Speaker 1:If I came in and said hey, brian, dr Schmutzler, I've had just one old-fashioned before my surgery. I probably still wouldn't do it.
Speaker 2:A truly elective procedure, gotcha, I probably would not do that procedure. I'd say why don't you come back another day? Because of the physiologic effects. So the biggest thing with all of these drugs but marijuana is what we're talking about are the physiologic effects. So I mean we can go from top to bottom, right, we can go all the way from top to bottom. So generally they cause the anesthetics to work less effectively. Nobody knows exactly why. There's maybe some tolerance component of that. There's some of the same receptors that they hit. But even people who don't smoke that much marijuana and I, you know, I don't, I don't read the literature enough to know what a lot of marijuana is but people who maybe smoke every couple of weeks or once a month or once every three months, there's still a change in the needed dosages of the anesthetic really yep so something changes within your physiology that way.
Speaker 2:Okay, so you've got brain as well. So, so people who smoke a significant amount of marijuana already have some cognitive deficits. Anesthesia increases cognitive deficits and can prolong, have prolonged effects. So older people with, let's say, alzheimer's or dementia often have worsening Alzheimer's or dementia after they have a procedure Because of the anesthesia, because of the anesthetic yep, yeah, so that same effect is now being seen in people who smoke significant amounts of marijuana and again, I don't remember the exact amount that makes it significant. But people who are chronic marijuana users have more side effects from the anesthesia cognitive side effects from the anesthesia.
Speaker 2:Okay, so let's just keep going down. So you've got lungs right. Anybody who's smoking marijuana, you have to treat them like a smoker of cigarettes. Okay, so they've got all the effects of the cilia, the little hairs that are inside your bronchials. They don't move the right way because you burned them all off.
Speaker 2:You've got increased mucus production and then you've got an increased chance of an irritated airway or an active airway, a reactive airway, meaning that you know you might have some sort of called a bronchospasm, where the bronchi close down, or a laryngospasm where the vocal cords close down from the smoking the marijuana, there are significant cardiovascular effects, so blood pressure changes are more intense, higher and lower. You probably are causing some because of the smoking and the fact that vasculature is opening up and closing in ways that it shouldn't, and I don't know all the complex physiology of it. You probably are causing some coronary disease. Okay, okay, you're definitely having a labile blood pressure because they're used to a certain amount of medication or a certain amount of drug in their system and you're giving them anesthetics that throw that off and they're all over the place super high, super low. So nausea and vomiting Again. They have worse nausea and vomiting after surgery.
Speaker 1:And some people already have that to begin with, right, yep, yep.
Speaker 2:Yeah, so worse nausea and vomiting after surgery. And in general, people, if you take the same cohort for the same procedure, people who smoke significant amounts of marijuana regular chronic marijuana users do worse in almost every category of every surgery after surgery. Here's one that I uh, and hang on, let me get to it here because I want to make sure that I uh, that I cite it correctly cardiovascular effects. So uh, okay, so they need more pain medication also after surgery okay and this is the new data.
Speaker 2:It's a 2025 study that that they don't know why. They don't know how chronic marijuana users are less affected by regional anesthesia. Local anesthetics do not work as well on people who smoke, who are chronic, chronic marijuana smokers.
Speaker 1:So that means like let's say, I don't know, you're having a block done.
Speaker 2:Yep, you have a numbing block. It doesn't work as well if you're a chronic marijuana user.
Speaker 1:So what I mean? Does it require more dosage? Is it just it doesn't work. The nerves don't respond the same way to local anesthetic after you have chronically used marijuana to local anesthetic after you have chronically used marijuana, and that doesn't matter, because some of the things you were describing is the smoking of marijuana. Yeah, this is any THC usage.
Speaker 2:Correct, yeah, a lot.
Speaker 1:You know, again, in recent years, gummies have become so prevalent and it's not just gummies, right, we have become so prevalent, so right. And it's not just gummies, right, we're seeing it in vodka, right, we're seeing it in different forms so.
Speaker 2:So here's the problem, though that's not regulated by the fda, okay in general, and so you don't know how much cbd is in that, how much thc is in that, because it's almost impossible and the lingering effects of cbd is 30 days.
Speaker 1:Right, I mean it's what do you mean? Lingering effects so do you mean physiological bloodstream?
Speaker 2:you mean, can you measure it in your blood?
Speaker 1:I mean let's go to measurement in blood it's.
Speaker 2:It's. It's dependent on the amount of use, but it is up to 30 days if you are a chronic user.
Speaker 1:So up to 30 days for measurement in your bloodstream, but that doesn't mean it's physiological but, physiologically active is how long?
Speaker 2:probably a couple of days, okay, yeah but that these dose depends depends on the dose, depends on the route that you take it right, smoking.
Speaker 1:It probably lasts less time than if you were to chew up a gummy, depending on how much is in there so a lot, of a lot of these gummies, let's just say, are kind of balanced now, so they're one to one, which means supposedly thc to cbd. Cbd, yeah suppose, but you're saying that cbd in itself is also a problem when it comes to any.
Speaker 2:It's not okay so the majority, the majority of the what we call in vitro studies, where we study, um, basically cells in a lab, show that the thc is what causes the problem. Okay, right, the cbd. If you could isolate enough cbd, that probably has very little physiologic effects.
Speaker 1:But again, you're right, it's not fda approved so you're saying it is on a label saying one to one, right, who knows Right. That could just be their general measurement of saying, hey, there's protein in something, right? Yeah, we've talked about that before.
Speaker 2:So supplements like if you don't get your supplements from a and they've done these studies before if you don't get your supplements from a verified vendor of supplements who actually does the studies? I mean, sometimes they're like oh yeah, this is vitamin C and there's like one little drop of vitamin C and the rest is sugar. Yeah or whatever, yeah, whatever, it's fiber or something.
Speaker 1:Right, you know in there. So when it comes to gummies, same thing.
Speaker 2:You just don't know it's in general not regulated by the FDA and thing it's. You just don't know it's in general not regulated by the fda. And so you go and buy a gummy. You're like, oh yeah, it's cbd. Who knows, it could be 90 thc, it could be 90 cbd. It could have very little of either and have some other you know inactive substance in there. So you just don't know that is really interesting.
Speaker 1:Is there like a push because it's become so prevalent? Has there been, or do you think will there be, a push to get this exam to try and test it? Or are you like it happens so infrequently that we're not really worried about it?
Speaker 2:I mean, most people who are going out and getting a gummy are not trying to dose themselves perfectly. So I can't imagine. I mean, I'm sure there are some companies, just like with other supplements, there's some companies out there who do really good testing you go and it says one to one or two to one or six to one or whatever. That's actually what it is.
Speaker 1:Let me rephrase my question, meaning prior to surgery. So getting a test prior to surgery saying oh, I see what?
Speaker 2:you're saying yeah, yeah, yeah.
Speaker 1:Prior to surgery we're going to do this test Are you intoxicated or how much do you?
Speaker 2:I mean, I can tell if you you'll in a urine test, you'll pop positive for thc, but that doesn't tell me if you smoked it 30 days ago, three days ago, 10 days ago or five minutes before you walked in the door and to bounce off that question, I asked you about measurement.
Speaker 1:If you get surgery within 30 days, let's say of that whatever and it's in your bloodstream, does that affect anesthesia? Probably? Probably which is I mean, that's that's interesting to hear. I mean, it's a wound healing. That's the other thing I didn't mention.
Speaker 2:That's a surgical complication, not an anesthetic complication, but it does affect wound healing as well. It decreases the ability of the wounds to heal, just like smoking cigarettes does. So there's a lot of ill effects of these things and I think the other problem. So if you look at, let's say, the marijuana that people were smoking in the 60s and 70s, even though it was illicit, even though you didn't know what necessarily was in it, the potency was way less than what it is now. Right, the hydroponic grown government stuff is like apparently super, super intense, super concentrated. You go back even further, when they first started pulling the marijuana plant and just rolling it up and smoking it in the field and whatever, 2000 years ago. The potency even from there to like the sixties and seventies, is infinitely more.
Speaker 2:And then now it's, it's even more than that. So you you're dosing yourself. It's such huge doses and everybody does this like, oh, it's from the earth, what? Yeah, kinda, but not really anymore, right, it's. It's like. It's like when you you're genetically engineering this stuff to have huge doses of thc in it, as opposed to what's what was naturally growing in the earth 2 000 years ago, that they, somebody, might have picked off and smoked and gotten a hundredth or a thousandth the dose of thc cbd is what exactly Like, physiologically speaking, it's one of the other molecules within marijuana.
Speaker 2:The two molecules are THC and CBD. They bind to different receptors. So the THC goes more to the portions of the brain like the limbic system and the frontal temporal lobe where it deals more with, like your cognition. The CBD goes to more places that deal with there's a little bit of emotion to it, but also regulation of pain and proprioception, so how you feel things, and balance and that sort of stuff. So CBD does more of the neurologic effects. The THC does more of the psychological effects. Now, that's not. It's not as clean as I'm saying here. Right, it's super complicated, but if you were just to say explain it in a most simple way possible, that's kind of what I would say the differences are that is really interesting.
Speaker 1:It is really interesting to dive into this medically speaking instead of just kind of yeah you know. This is what it does for you. These are the good things these are. You know the. This is what it does for you. These are the good things these are. You know the benefits, but there are a lot of negatives to a lot of these, especially when they're not FDA-approved substances.
Speaker 2:Yep, and I would question everyone Do you think that society has gotten better because that we've legalized marijuana, or worse because we've legalized marijuana?
Speaker 1:I'm just playing devil's advocate here. Could we be asking the same question about alcohol 100, 100? Could yes that's just me playing the devil's advocate?
Speaker 2:I, I'm not. I'm not disagreeing with you at all. I think that there are a lot of bad things that alcohol I mean alcohol is a poison, right, so that the reason that I mean alcohol is a poison, right, so that the reason that you get drunk is that a poison shows up in your body and makes you dizzy and talkative and throw up and all that kind of stuff. Again, though, I go back to the fact that you can and a lot of people do have a glass of wine or a, a sip of bourbon or a mixed drink, because they enjoy the flavor of it and they stop. You can drink alcohol without becoming intoxicated. You cannot use marijuana without becoming intoxicated. That's the whole point of the drug.
Speaker 1:It. You know it does bring up an interesting. You know you could be on both sides of this right. And again, this is not a political issue.
Speaker 2:We're not making a political issue.
Speaker 1:I can guarantee that both people on the right and left drink alcohol and smoke marijuana. You can guarantee that it doesn't matter what side of the corner you're on there, you are partaking in both. It doesn't matter. But it does raise interesting questions about hey, is this medically good for you? And I think the understanding for so long quote, unquote, because it really hasn't been that long but for the last what? 20, 25 years?
Speaker 2:Yeah, I think it was early 2000s that Denver or that Colorado legalized it.
Speaker 1:You know, we're all not, we're not taught it, but we're all under the impression from the marketing side of it that oh it's a right, it's a safe alternative to alcohol. That's right.
Speaker 2:So here's the other thing, though the one positive side of legalizing it in several States we can now study it. So that's why these studies come out, that's why and and the huge thing, the whole reason that I wanted to even bring this up is I saw that article about that that using chronic marijuana use changes your, your responses to regional anesthesia like that's crazy, blew my mind.
Speaker 2:So that's the whole reason I even wanted to bring it up today, but yeah, so one other thing, societal wise. And you see this, because we live a couple miles from michigan, nobody wants a dispensary by their house, right, correct? Why, come on? Why don't they want a dispensary by their house? Well, I mean, because of what it brings with it, correct, right? It brings a drug culture with it, correct? So nobody wants that dispensary by their house nobody wants that kind of traffic right.
Speaker 2:But also that traffic no, there's. There's a lot of crime that comes with that. That's what I mean with that traffic.
Speaker 1:They don't traffic right, they don't want everything that comes with the dispensary correct and this was I, was I was going to say about this and you asked the biggest question of all today is is our society better because of marijuana, the legalization of it, the popularization of it? And now that can be answered in a multitude of different ways.
Speaker 2:That's why the question was posed. It was rhetorical ways.
Speaker 1:That's why the question was posed. It was rhetorical how much monetary benefits has it brought to cities, to states? Now you could argue on both sides of that coin too. Probably could. Yeah, because what's the cost to it? Correct the taxes, the, but what's?
Speaker 2:the societal cost, correct financial cost, because of all the complications that come with which I don't know if we fully understand that yet.
Speaker 1:I don't think we do. I don't. I don't think we fully get that yet right, but the but the okay. It's bringing in this amount of money colorado made, I mean what is the first question?
Speaker 2:we ask how much billions of dollars banking billions of dollars?
Speaker 1:exactly a year in marijuana sales. Now we have found out that that's not exactly the case with these cities, right? I mean, we see it right across the border, Some of these cities in Michigan. Like it's not exactly the case. You're not becoming a millionaire by opening a dispensary. Correct the margins are small. The margins are very small.
Speaker 1:It costs a lot of money to farm that stuff and for all the security and for all that, there's a lot of that too insurance, you know, yeah, the list goes on and on, so we're seeing that it's not exactly what we thought it was in terms of let's open a dispensary here and here and here and here and and uh, so again, right, I think both sides of the coin. You're seeing that, but you can see multiple answers to that question of is it benefiting society, and there's a couple of the things to address here now.
Speaker 2:So I guess you could make the argument that legalizing it makes it safer because of all the stuff that they're now putting in and on marijuana, including fentanyl We've talked about this before right? So if you get marijuana that's laced with fentanyl, you could die. You buy that from a dispensary. I think it's very unlikely you're going to get it laced with fentanyl, right? That's true.
Speaker 1:Right.
Speaker 2:So maybe that's an argument and here's maybe the centrist view, and I'm not saying I agree or disagree with this. But the other thing that's happened is like we talked about decriminalization, right. But the other thing that's happened is like we talked about decriminalization, right. So not meaning that it's legal. It's still illegal. But you're not putting people in jail for 50 years for three marijuana offenses, right? The majority of people who are even selling marijuana are not killing anybody, like people who are selling heroin like people who are selling, you know, fentanyl and that sort of stuff, right?
Speaker 2:So I mean I could maybe be persuaded that decriminalization in some way shape or form is reasonable. Maybe.
Speaker 1:But I have one interesting thought and I'm just putting it on the table here. So we're talking about you. You know, anything that goes in the lungs that's going to hurt your adult damage chances of recovering from anesthesia more and more. Yep. Now you brought up a word that I think is interesting fentanyl. Uh-huh, because, let's say, you get marijuana laced with fentanyl, you said you could die. Yeah, certainly so. Everybody thought that moving away from cigarettes would be safer, would be safer to vape? Oh, no that. So hold on, hold on, don't get me started on vape. And why have they removed some of these vape brands from shelves?
Speaker 2:Because they're not regulated the way they should be and some were laced with fentanyl, some were laced with vitamin E that damaged the lungs. You got this popcorn lung thing. So, as a physician, I will tell you vaping is not safer than cigarette smoking and is probably, in most cases, worse than cigarette smoking. Because the heat, because the chemicals that are in it.
Speaker 2:Yeah, it gets hotter. There's a whole lot of things that. So in general, you should not be smoking anything. The body was not created to suck hot smoke into the lungs. It just was not so, even if you're smoking air right? Even these guys who do the fake steam cigarettes for movies and stuff oh sure, Even those cause lung damage. So don't smoke anything. Like I will take a stand. I don't think this is controversial. Don't smoke anything and I'll be honest with you. I think cigarettes should be illegal.
Speaker 1:There is Well, you see less and less, I think.
Speaker 2:I don't know. There's a lot of people that smoke really yeah because what I've seen, the trend is vaping.
Speaker 1:Vaping, yeah, you know, and I see people go away from the cigarettes to pick up vapes but we we know that cigarettes are.
Speaker 2:There is no positive effect of cigarettes and a lot of negative effects of cigarettes.
Speaker 1:But also like Well, there's one positive effect for certain people. What's that? Tobacco companies. Oh well, yeah, money, money, right, yeah, I mean, you know what I mean.
Speaker 2:There's no reason that cigarettes should be illegal. Right, I mean they literally are cancer causing. That's all they do is cause cancer, so there's no reason they should be legal yeah, go ahead you know, that's what I was finished that's a good point.
Speaker 1:I, I and the last uh comment I'll make is this or question I have is this and in terms of people who have said listen, 20 years ago in in college or whatever it is, I smoked marijuana, didn't inhale bill clinton depends.
Speaker 2:What your definition is is didn't inhale it. Uh, you have to be of a certain generation to even understand and get that but people who are like you know, I'm gonna switch to the gummies.
Speaker 1:I'm gonna switch to the food aspect of it. I'm gonna switch to, you know I'm going to switch to the gummies. I'm going to switch to the food aspect of it. I'm going to switch to, you know, the liquid aspect of it. And you're sitting here from a medical perspective saying that's not any better.
Speaker 2:It's better for your lungs. I will say that If you're doing some sort of gummy or pill or whatever, it's better for your lungs. At least you're not destroying your lungs. Is it better for the rest of your physiology? No, but at least it's better for your lungs.
Speaker 1:So you know what Gen Z calls marijuana. What's that? Zaza Zaza Gas Dank Flower. I've heard dank before.
Speaker 2:Fire.
Speaker 1:Yeah, they're calling it dope still, but yeah, boof.
Speaker 2:I don't know what that is so loud do you do? You think this will be controversial?
Speaker 1:I'm wondering if we'll get lots of comments on on this, if we think it'll be controversial um, because there I think there's a lot of people who are advocating for it, for sure, who are definitely advocating, advocating for marijuana use, the legalization of it, but I think those same people and again comments below, let me know if I'm totally off base here but the majority of those people who are advocating for it are already smoking it and taking it. True, probably true.
Speaker 2:So what's the use of like? Because then you can go down the street and get it.
Speaker 1:True, probably, true, so what's, what's, what's the use of? Yeah, like, because then you can go down the street and get it.
Speaker 2:Yeah, yeah buy it in a store instead of off the street.
Speaker 1:Yeah, you know. So I, I don't know. I mean like when, when you know again, it hasn't hit every state.
Speaker 2:Yeah, right, right yeah, I don't remember how many states. Indiana, ohio, indiana is completely illegal. Yeah right, that's what I'm saying. Yeah, I don't even think there's medical marijuana.
Speaker 1:No, I mean there's there. It's not legal, not legal, yeah, right, um, and again, the states that you're seeing them in are more right, progressive, progressive states, um, and so I mean again the will it be a controversial topic? I don't think it'd be controversial. I think we'll have many people vocalize okay, their viewpoint.
Speaker 2:I'd be willing to debate somebody on on marijuana. Listen, I I'm not an expert, I'm not. I gotta look it up.
Speaker 1:This is not a you know court system here I, I have dabbled, I passed, I did not inhale Is is. But yes, I have also seen gummies firsthand. Yeah, it's hard to know, and this is why I don't really condone it, because you lose functionality of your body.
Speaker 1:You are out of control when you're not intoxicated when you're not in control of your functions anymore and your brain, that's a scary place to be and you don't know. You don't know what you're smoking, you don't know what you're taking correct, that's the also the big unknown there.
Speaker 2:Cbd okay, whatever, if you know, if you know what, if you know it's cbd though right, correct.
Speaker 1:I mean that's, that's, and you see, like cbd shops all over the place right, I mean we have some down the street here, right, yeah, um, and so again, that's the unknown. I think in alcohol it's known, it's it's very well regulated.
Speaker 2:Yeah, it's, it's regulated. They didn't have that issue in mexico, right where they were, where people were like drinking alcohol and it wasn't.
Speaker 1:What is this?
Speaker 2:yeah, it wasn't actually whatever they're supposed to have trust me.
Speaker 1:Trust me when I say this don't go to beale street in memphis and take shots of alcohol on the street.
Speaker 2:Yeah, don't do that. I would recommend a beer. Take it from me personally. Don't do that. I would recommend a beer that they have to open in front of you.
Speaker 1:Yes, at least you know that it's. Yeah, have it in the stadium. That's right, you know where it's coming from.
Speaker 2:That's, but that goes right back. So what you just said, though goes right back to what I said at the beginning, is you shouldn't take a substance that intoxicates you. There's nothing beneficial that comes from being intoxicated. My opinion Bars, huh, bars. What does that mean? That means the end.
Speaker 1:Oh Bars, is that a Gen Z thing? I don't know, I think so.
Speaker 2:I think that's what gen z, gen alpha, likes to say I hear lots of I hear lots of bet I don't know, what that means. Yeah, that means like yes, yeah, yeah and um, uh, uh, oh, slay, is that?
Speaker 1:slay. My son has been saying recently a lot cook. Oh, it's gonna cook, cook or or actually like meaning for sure. But really I'm questioning it too, like actually, uh, is that a thing?
Speaker 2:that's a thing like they say it at the end of, like a word yeah, it's true?
Speaker 1:that ends our seminar on cannabis. All right, I don't think we said cannabis I think that we didn't say cannabis.
Speaker 2:Yeah, we said marijuana. Yeah, cannabis is the uh plant genus.
Speaker 1:So there you go, ending on a scientific term yes yes, this has been going under anesthesia. Answered with dr brian schmutzler. I'm vahid sadarzadeh. We're brought to you, as always, by the butterfly network and we'll see you. See you next time in the next one. Bet bars slay.
