Support for this podcast comes from Wells Fargo, which donated more than nine million dollars to Pennsylvania nonprofits last year, including the enterprise centre to help grow local divers owned small businesses. More at stories dot W, F dot com slash Pennsylvania. Supporting WHYY Penn Orthopaedics with advanced treatments for hip and knee arthritis and a personal patient. Navigation team the Penn Orthopaedics approach to joint pain is designed to help get you back to enjoying life. Again. More at Penn medicine dot org slash joints. Major funding for the pulse is provided by a leadership gift from the Sutherland family charitable fund. The Sutherland support WHYY and its commitment to the production of programs that improve our quality of life. This is the pulse stories about the people and places at heartfelt and science, I Mike and Scott the small town of Hanes Alaska is a popular destination for cruise ships tourists. Love the views of snow covered mountain, peaks and sparkling blue waters. You can spot bears eagles and moose and last year. The town added a new attraction a shop called winter greens. Inside the walls are painted bright green and the shelves are lined with bonds and buds winter greens is marijuana store customers or picking out pre rolled joints much like you. Choose lunch meat at the deli counter. Nocco Poku goal. In a sugar Mongolia. Recreational marijuana has been legal in Alaska for a few years now, but the customers here say they're still adjusting to this new normal. People were totally against my. I mean, it was dead wrong. I got Trump when nineteen eighty over marijuana. That's Jeff Taylor. He says marijuana helps him control pain another customer carry kinison agrees. It's seen as a medicinal product. Now, which I think is great and people don't have to hide. And you know, you gotta pain you can go take care of it. Now and natural homeopathic way. Think about it. That's a pretty stunning transformation from being seen as dangerous substance. It's a fact pot hurt to benign healing potion times of change greatly till now, it's unbelievable. The change. And with all of this have come new issues states are sorting out their legal approach to marijuana dispensaries are opening up all over the country. Some researchers are worried that we are underestimating the potential harm marijuana could do society has jumped very very very far ahead of science on today's episode will look into marijuana and the new normal and some of the questions that are popping up along the way. Let's start with medical marijuana, which is now legal in thirty four of the fifty states. What does the move from illicit substance to legit treatment looked like on the ground list tongue? Went to find out in Philadelphia. Word dispensaries are still pretty new. I'm standing on the sidewalk in front of beyond too low. It's one of the most popular marijuana dispensaries and from the outside. It looks kind of like an upscale spa like frosted glass. Storefront really easy to miss. It's supposed to be my introduction to this shiny new world of medical marijuana goes waiting. Over except for one problem. Do you? Do you have to have your ID or something to? Medical marijuana cartoon a dispensary. I'm not allowed inside despite a very gracious invitation from beyond Hello. The Pennsylvania department of health says that no one without a medical marijuana card, including journalists is allowed inside dispensaries. I get it. This is all new stuff. They're still figuring out access. So a scrap my dispensary plan and decide to go for the next best thing, you're at Filiasi. This is the Philadelphia Tempur Pedic cannabis is a culmination of many years of thoughts and kind of hopes that's Patrick Duff. He's the co owner affiliated see it's a kind of combination head shop and cafe that caters to people who use medical marijuana to be clear. Philly TC doesn't sell cannabis. They don't dispense it for medical or any other purposes as co owner, Raymond Bunga says more of patients consumption lounge and CBD consumption lounge and and Sacramento holy place for for the use of cannabis as a. A Sacramento and or medicine customers can do that sitting at one of their diner? Style booths that they have in the back either using their own setups or the shops vaporisers until they called rigs. This is a kind of a tall one that I like to use to vaporize the rake resembles a small sleek water Bong except that instead of a lighter Patrick's using what he calls an herb iron. It's like a pen with a heated ceramic, and I'm gonna use that tip to kind of just dance on the top of this. So I don't really fully ignite it like lighter woods. So there's no real combustion in Pennsylvania. You're technically not supposed to smoke medical marijuana because of the health risks. You're supposed to keep it. Which is what Patrick is demonstrating right now. So that was. Patrick and Riemann open the shop a few months back. They operated out of three room storefront that sits between kind of gentrified hipster neighborhood and Kensington the struggling area that as reman points out is best known as the heart of Philadelphia's opioid epidemic, Ohio. I'm happy to be a part of the change and just bring in better vibes to this neighborhood. It's the only establishment of its kind in the area and kind of the perfect embodiment of where things are right now with medical marijuana, which is to say in the gray in between. It's not exactly legal in the sense that establishments. Like, this are so new they aren't yet regulated. But it's not illegal either. It's out in the open. They have a sign out on the sidewalk. But it also offers privacy a safe space for people who can't consume at home because they have kids or because they live in government subsidized housing, and then they're the owners themselves. Raymond loves talk. About counter cultural heroes who helped advance our understanding of cannabis when it wasn't legal. Well, Patrick spent years out in LA running other cannabis churches places that he says basically acted like underground dispensaries. An even got busted by the authorities. If you times, but both of them are also very much invested in medical marijuana, shiny new completely establishment future all of which puts Philly teach seat in a unique position as a link between marijuana's past and its future. We provide a different service than anybody else provide right now. And what is that service? How would you define educational service number one showing people how they can sign up to be a patient. But more importantly once they become a patient. They can come in here and ask questions about the medicine. They're like the spirit guide for all these brand new medical marijuana patients. Many of whom started out having no idea what they were doing. They actually helped me a lot of learned a lot even from coming here. Megan M is one of. They're regulars. She asked that we only use her first name because of the stigma against marijuana Megan's in her late thirties, just long hair and a wooden cane and she sitting in one of the booth here showing me what she's learned this is a rig this is a traditional rig. So you put the product in the slope here, you only need about the size of a green of rice get that in there. So that it melts. And. That that's pretty much it. That's that's how you medicate. This has become a daily routine for Meghan. She got her medical marijuana card a little over a year ago. And she says it's changed her life for the better after five years of pain and struggle, it all started back in twenty thirteen Meghan was thirty three and working at a corporate supply for a large energy company had recently bought her own home own all life was good. And and exactly where I thought it would be at that time. But in January twenty thirteen Meghan got sick the flu. And in a kind of freak medical occurrence the flu virus attacked her heart causing her to suffer three strokes Megan's life was saved, but she spent months in and out of the hospital and another year recovery and basic life functions. I had to through you know, therapies and exercises. Retrain, my body how to pretty much do everything again, right again, walk again, you know, different. You know through occupational therapy, different tasks. Home. Even you know, maintaining yourself in the daily activities of life. Megan had hoped that once she recovered, those basic functions should be able to go back to work. But there was an even bigger problem damage to our nervous system, which resulted in ongoing and unbearable pain. My understanding of is that my brain is just constantly sending pain signals out. And it's because it's basically got fried rain gets a little bit. So I feel pain. It's just stiffness. It's just aching pain. It's burning. It's kind of unbearable to like, you don't even want move Megan's. Doctors ended up prescribing various opioids to treat the pain. They did the job. But Megan hated the side effects. She felt like the opioids clouded her thinking the affected her sleep and her mood. But there was no alternative until February twenty eighteen when medical marijuana I became accessible to patients like Megan by this time Megan had been on painkillers for five years. And she was more than ready for a change again. When you're kind of stuck in the rut frustrated, you want to try anything and everything, you know, seeing people being able to either completely get off some of these narcotics, or at least decrease the amount they need that was something. I was highly interested in it so Meghan gave it a shot. She got her medical marijuana certification. And then she headed out to a dispensary. She's gone to a few of them now. And she says it really does kind of feel like going to a pharmacy with one key difference since this is still federally illegal. It cannot be technically prescribed. So it's recommended by a physician that's a mandate coats. He's a pharmacist at the dispensary beyond too low before that she spent ten years as a conventional pharmacist a switch, which by the way, she says required. Shockingly little training will also with this program. We have to four hour course to get your training certificates to become a practitioner within the medical marijuana program. Anyway, as a pharmacist Amanda has lots of experience working with patients, which is good because she says a big part of her job is walking new patients through their options. Like as a pharmacist a lot of the patients that are coming to me have never even tried cannabis in the past. So we're starting with cannabis patients. It's her job to help them figure out which stream to take. And how often what are they should vape or tinctures capsules end, of course, their dosage it's a little bit about what their comfort level is starting low and slow is like our mantra, Amanda says it's really important for dispensary staff to get to know their patients because unlike with other drugs, she can't just look up some study about how ex tincture affects pain related to Huntington's because a lot of those studies haven't happened yet. She has to take into account the disease the profile of different marijuana, strains the form they're taking along with patients using credit concerns. For example, Amanda says a lot of patients don't wanna get high. They see you for you. Is a very unwanted side effect. We're trying to get in that sweet spot where they're getting symptom relief, but they're not really feeling about euphoric feeling, but striking that balance can be tough for patients. Like, megan. She says for her controlling her chronic pain was a matter of trial and error, for example. She started out vaping the cannabis flower itself. Now, she uses a couple different concentrates essence of cannabis if you will which she says works a lot better. They feel later and the leaf affects remediate more media than any other form for me months. Leader Meghan says she's mostly fine tuned her approach which concentrate she uses and how often dosage and how to balance it with other meds. But it still isn't 'perfect. She's still experiences pain and still has to take opioids una pretty regular basis, and she still isn't comfortable using medical marijuana out in the open. The stigma is real I am own experience. That is just kind of better to be. A pick and choose. So you know, when when and where to share she says, she plans on keeping it that way at least for a while until going to the dispensary is open and easy as a trip to the pharmacy. That was Liz tongue reporting. And I was surprised by something the pharmacist in the dispensary said that it took only four hours of additional training to get this new job at doesn't seem like a whole lot right to work with marijuana exclusively to discuss with people what strands to use for what? And that got me thinking about healthcare professionals in general, you know, when you go to your doctor's office or the hospital. They'll usually ask you about marijuana use because maybe it could interact with medicines, you're taking or cost health issues. And I'm sure sometimes patients will want to ask their physicians about medical marijuana. How much do doctors really know about this? I I went to medical school not that long ago. And I don't know if I fell asleep during his class or they just breezed through it. But I actually really don't have a good understanding of how marijuana. To work, that's emergency room, physician and regular pulse. Contributor, Avia Meacham. He wanted to get a better sense of what THC and CBD do in our bodies. He went to visit Margaret Haney. She is marijuana researcher. What I often say is this is an old old drug, but a new science. She's also a professor of neurobiology at Columbia University. It's not surprising to me, you haven't learned a lot about it. I think in medical school. They don't teach a lot about substance use disorders in general, let alone their neurobiology lemme start then from the beginning someone lights a joint takes a hit. What happened? So smoking is a very very effective drug delivery system. The the chemicals in the plant get go goes through the lungs directly to the brain. Okay, in what are these chemicals? Exactly. We know there's a hundred or so chemicals in the cannabis plant that are unique to the cannabis plant there called collaborates, and we understand one of them delta nine THC fairly well because delta ninety h c is the chemical that really produces the classic marijuana affects scientists call it delta nine THC, but most of us just call it THC. That's what defines potency, you know, when you're trying to buy the most potent marijuana, you want the highest level of delta nine THC. And that's how it's described now in order for this THC to have an effect inside you it has to attach to receptors that are patiently waiting in your brain they discovered in the nineties this receptor canal receptor just a protein in the brain. And it's everywhere in the brain the cabin receptor also called the CB receptor is like a lock THC. Is the key and the door that's opened. Well, that's the high the alteration in sensory experience changes in time perception, the munchies the intoxicating all of that does that mean that our brains are wired to receive marijuana or I asking this in a weird way. But but why do we have these can yourself? Why do we have these receptors for canal, which are from a plant? You know, like most drugs of abuse that the the drugs, we abuse mimic, the chemicals in our brain already. And so there are chemicals liked THC that our body produces and play an important role in brain development in brain function. And so just by happenstance, delta nineteen in the plant also binds to that senior center. So it's so what sei sampling all these different plants over over millennia. We've discovered the ones that can kind of trick our brain. It turns out we make our own Endo cabinets chemicals that bind to those Kavanag receptors their purposes still. Kind of a mystery. But they may be involved in modulating stress, memory and pain. All right. So delta THC a K THC. That's something that we've known about since the nineties, but to me, it's only recently that I've been hearing about CBD's, what are CBD's can dial is another cannabinoid president in the cannabis plant very very different than delta. Ninety eight see at doesn't bind to the same receptor. Its mechanism of action is is pretty poorly. Understood so far, it's not getting you high and there's been great hope in its medical potential. There is now an FDA approved form of canal dial for severe forms of childhood epilepsy. For example, CBD or canal? Dial is everywhere. Now, you can buy oil at the corner store, and you can eat it. You can use it in your cooking or on your skin people use it for anxiety pain, or lifting your mood. But there's almost no scientific evidence behind any of this. There are other areas that are very very, exciting and intriguing. To study for Kappa. Dial, but society has jumped very very much very far ahead of science. So cannot be dial has promised for certain indications, but the data is very sparse. And it's been hard to do carefully controlled studies. So as a scientist, it's very distressing to for me to see how ubiquitous it is throughout the country, and how people are using it in all different forms and shapes and doses, basically, just the wild west, right? It is. And it's it's it's worse than that in that in lieu of data. It's really marketers and people selling Cabot I'll making money from it that at our informing the public about its its effects, it's medical benefit. And that's that's not good for anyone. I guess is what happens when you listen to Facebook too. You told me about THC and CBD are there other compounds that are like actively doing things to us when when we smoke it. So that it we don't know of the one hundred or so canal. We know a decent amount about THC a teeny bit about CBD. And as for all the rest, we don't now. And the reality is most of them are in VR. There's there there in low concentrations in the plants that people have been smoking for a long time. But there is the potential right there. These other compounds may do amazing things or they may do terrible things. We just don't know. The problem is even though some states have legalized marijuana. It's still federally classified as a schedule. One drug. That's the designation given to the most unsafe drugs known to man that designation makes it really hard for scientists to get their hands on it. So I can get at the Bodega. But if I want to study, you can't do I can't get it that was emergency room physician of Metra on a quest to learn. Learn more about THC and CBD we're talking about the new normal with marijuana smoking weed is becoming more and more accepted in a no big deal. Kind of way. Nick, Missy a self-described pothead says that way of looking at we'd no longer works for him this drummers grove in prospect park in Brooklyn, New York. It's right by my house now used to come here lot. But when I quit smoking, we've started to stay away drum circles pot are frequent companions. But here's the thing about this city. We'd is everywhere. I smell it all the time. And sometimes it's no big deal. But other times, it's really triggering. See? I'm an addict a pothead addicted to weed you might not take that seriously. But I'm going to make the case that you should a quick recap had a big heartbreak in school. We'd helped dropped out of college. We helped arrested for dealing smoked before court. Got a slap on the wrist celebrated with joint crashed my car broke my neck toss the weed right out the window. None of that made me want to quit that came years later one day. I just noticed. I was paranoid. All the time. Rushing home every night after work to smoke alone. But when I tried to stop I couldn't cold Turkey. Didn't work therapy didn't help neither did antidepressants. And every time I thought about checking out a recovery program. I think of half baked that cults donor flick starring comedian, Dave Chapelle, his character is a pothead, and he tries to quit smoking to my name is Thurgood. He standing on a stage addressing all the other addicts. I'm here today because I'm a dictated to marijuana. Marijuana. Marijuana's is not a drug food this, man. Home. Larry's, but some experts aren't laughing anymore climate. I'm a policy analyst by training. Mark works at New York University. He's written a few books on marijuana policy in the United States. How many people like me are there? How many people are there? Do we know that dentistry has potheads who wanna stop something like four million, man? Yeah. Looks like about a third of the people who use every day or almost every day meet the diagnostic criteria. Forget it was used as order the criteria. According to Mark trying to cut back in failing. At it. Knowing marijuana is messing with your life goals and still getting high all the same. He says there's a growing number of people in the US like me people who wanna cut down or stop altogether. He thinks maybe it's because the weed itself is more potent these days anything less than fifteen percent THC is a rip off the back in the nineteen seventies. It was three to six percent THC harder to get addicted to less dangerous certain dangerous compared to uncle the drugs changed. In the meantime, do you think? We ever underestimated. The issue of problem users when we started examining issues around legalization. I don't know. But we sure noted he says about thirty years ago when they looked at people who had used marijuana in the past month. Only eleven percent of them were daily users today Mark says that number is more like thirty five percent again about a third of them report. The symptoms of cannabis users order and those heavy users account for about eighty five percent of the week consumes one of these things that I encounter all the time are people who like to tell me that. I can't be an addict, what do I say to these people? I mean, I know what I'd say them. But I can't say on the air. I talked to Dr J Michael Bostick. He's a professor of psychiatry at the mayo clinic who specializes in addiction counseling, I told him the same thing. How people like to tell me that I couldn't possibly be addicted to weed that that is complete garbage. But again, if you go with the definition that there's a problem as a result of you use whether you're meeting your goals is the family member or as a. Apparent or as a spouse as an adult or whether potential your substance uses interfering with your progress. And it doesn't much matter. What other people say? So I tell him about how I started breaking promises to myself smoking earlier and earlier every day, for example, since it is psychoactive, I would say that you probably liked the way that it made you feel and on one level wanted to feel that way all the time. But on the other level may have felt I don't know you'll have to speak to this uncomfortable when you weren't high when you got up in the morning, I did feel that way. And as it went on I began to feel more and more uncomfortable all the time, and you probably increased your the amount that you were taking in. I sure did which is almost an exact description of any kind of addictive substance or practice. Anyway, that's how smoking everyday me feel, but I also wanted to know what it was doing to my brain. So for that I reached out to Dr Susan Weiss. A psychologist and senior science adviser at the National Institute of drug abuse. Hannah-beth is a very interesting drug because there is an entire signaling system called the Endo cabinet system. She told me the system goes through different parts of your brain and body. There's a hit the campus which is an area of the brain that's important for memory. And we know that marijuana impairs memory. There's also court ical areas which have to do with judgment and sensory areas. So people may find that things taste different or better. I didn't know it. But I was with this system multiple times a day. And when you do that if you do it repeatedly, then the system itself will start to down regulate, which means it starts to become less sensitive. And so you're you're affecting some of the normal physiological processes that this system is involved in and that's how addiction starts to develop. So these experts all tell me that the addiction can be real. But at the same time legalization is on the March, Washington, Colorado, California and many. More on the horizon. So I thought it would be good to talk to some guys in the field. Who argue for legalisation. I expected them to be like, hey, man. Calm down. Relax. It's a plant. But what they said surprised me normal not here can make the case that cannabis is on the harmless or innocuous because it isn't that's Paul Armand Tano, and he's the deputy director of normal appro legalisation group fact is if we are going to acknowledge that cannabis poses some potential risks. Then it only follows that those risks are best mitigated by legalisation regulation in public education in Paul's view. It's not that we'd is harmless. It's that jailing people for it is a lot more harmful, especially when the laws are used to put away people of color at a disproportionate rate. So Paul says, let's legalize it stopped the mass incarceration. And then we can focus on responsible public policy to address the risks. In the meantime, what are you supposed to do? If you like me, let me tell you how I quit. I finally found a support group for people like me people addicted to marijuana back in two thousand fourteen and nobody tried to tell me that we'd wasn't a drug or that. I wasn't an addict. Instead, I heard stories like mine smoking pot was. The one nice thing in my horrible life, and I had smoked and then I'd be super depressed and super anxious. I hear these success stories, and I wanted that for myself when you wake up in the morning, you know, for sure that you're not going to have to depend on something that will surely run out to be happy. I feel brave now I feel confident I still listen to stories like these I share mind to sharing listening. It all helps me stay sober. I don't know if this will help you or not I just want you to know there are people out here who take this seriously that aren't going to boo you, I know I won't. That was Nick Mercedes' telling us his story of quitting marijuana. Nick says we'd is everywhere. It's a way of life. There's a whole culture bonded. It's about community. And our next story speaks to that aspect. Here's Randy Scott Carroll with more. I'm in west Philly in a big mansion style row home. There's a million crowd of young people in live music in the basement. Mostly Philly rap. Someone's home. But I'm not sure who's I'm here to meet up with edibles maker Vicky who's here for an underground vegan. We'd event. When I arrived. The air is thick with that distinctive smell upstairs. Their vendors with tables filled with baked goods candies infused drinks, Mason jars full of fresh blood in all sorts of pre rolled joints. Vicki is selling her strawberry. Irish Sea must ice cream with a blue Burien fig sauce and a black bean, brownie crumble, all vegan in all infused with wheat. I I really enjoyed the feedback. When that after the event speaking I catch up by her car didn't as soon as they put it in mouth, they blue eyes lit up, and that makes me happy is that I light up. So it was great joy in it. Vicky whose business is off the grid asked me not to use her last. Name her usual clientele is more of an older crowd. She says they love the idea of relaxing without having to smoke. And so what she really loves this cooking full meals with cannabis oils out lakey, some soup out poison t just come spend a little time with me. That's all I'm asking. She invites me to replace to see how she makes her infused oils butter and tinctures in where she's turned his love of cooking into a healthy side. Also client stop by sit down. Enjoy some conversation and have a good meal and people pay twenty five thirty dollars a plate. I want to eat in dull healthy seasonal meal on want my food to taste like the season. You know, I want butternut squash soup with some kale in some came on. And I wouldn't mind having the aroma of a lovely. Kush come off that. The key is fifty years old with short hair, dyed gold in radiates, this inviting energy is she welcomes me into the kitchen. So I put an ounce about plus some other love bonuses in there to get things started. She tosses a bowl of fresh lead straight into this sort of crock pot looking thing on her countertop along with unrefined. Coconut oil. I don't have to do any work with this wonderful little device. It's called the magical butter machine it grind, stirs heats and chops infusing everything with just the press of a few buttons. It's literally called magical butter. About an hour later with adjoining their hand, the key scoops out the oil with a spatula scrapes it into the strain or smell nice. Well, it's sweet. Yeah. It just most like cleaner like it, smells like cleaners. Some of the residue from the we'd gets through this trainer. But she says she kind of likes that. I like it. Because when I cook when regular foods that gets in there kinda just use it as what do you call this stuff seasoning? So it blends in seasoning. I'm many Vicky says we'd was always an accepted part of her life growing up her father made a jug of tincture that he stored under the bed. Herodotus would also indulge. If only picnics Vicky says, she was always drawn to that side of the party. Everyone was laughing and chuckling, but that's what made the barbecue better. You know? That's what made the barbecue. Petr? I don't ever remember not being around in. Just remember my today. Vicky says her infused oils edibles are wave continuing the same sense of community from her younger days. It's never really been about the money. You know, if someone is hungry, they're in a little discomfort and pain, I can feed you and make you feel good. Vicky says everyone is welcome in her kitchen because we need some place just to take a break just the minute. I just need a minute IMP. Asides? Aren't we all special enough that somebody should take care of us? Like that for a moment. Like come on. That story was reported by Randy Scott Carroll. We're talking about the new normal when it comes to marijuana. Our attitudes of changed. The law has changed in many states. There are so many new questions and issues that are coming up, for example is cannabis safe during pregnancy. Michelle Illinois spoke with women about this in Los Angeles. Where marijuana is legal across the board. Let's start with the perspective from the medical community, which is pretty unequivocal don't vape. It don't smoke. It don't dab it. And don't eat it. That's the message from too big. Doctor's groups, the academy of pediatrics and the college of obstetricians and gynecologists they say there's just not enough data on how cannabis effects a developing child's brain clinical psychologist, Kelly young wolf does that kind of research. There hasn't been any evidence yet that indicates marijuana use in pregnancy is safe Kelly's research shows that despite the messaging from the medical world more women in California are opting to use marijuana. Anyway over. Over a seven-year period. The number of moms to be who tested positive for cannabis nearly doubled from four to seven percent. The rate was closer to twenty percent among younger moms, and this was before the state legalized recreational sales. We do know that perceived approval marijuana's increasing that people's perception of the risks associated marijuana are decreasing and this is true, particularly among young people, given how easy it is to get marijuana. These days Kelly says doctors should do more to warn their patients of the potential risks. The American Academy of pediatrics says research increasingly suggests smoking marijuana can affect how a baby's brain develops using during pregnancy has been tied to lower birth weights and could hinder skills that kids develop later in life like the ability to concentrate and control their impulses. But some women say they also have complications with their health to think about imagine throwing up. As many as four times a day in your first trimester. I would be driving, and I was just vomit out the window and hit a stop sign. Yeah. Vomit out the window keepdriving that's thirty three year old from Los Angeles. She asked us not to use her name because there's still a stigma around this issue and marijuana is illegal at the federal level. She planned to quit using cannabis when she found out she was pregnant, I stopped doing everything everything that I was putting into my body. I was thinking about my kid, but she was losing weight not sleeping and feeling stressed in worried. She was hurting her baby because she couldn't keep any food down. She went online found some of the same. Studies about marijuana that show risks for kids later in life. But decided there was some wiggle room. In some of those studies, researchers didn't control from others who were also using alcohol or smoking or the results were based on a small group of women she occasionally while she was pregnant. Her baby was born healthy and hasn't had any problems looking back on her pregnancy. This woman said she felt like she was on her own to figure out how to cope with her symptoms because she didn't connect with her doctor. I don't know. I just felt like she didn't hear me. I felt like she her concerns were medical. And so her mindset was what can we do to solve this medically where as I? Am a whole person with a life. And I felt like she had blinders on obstetrician Lena Nathan says she wants to be a listening ear. She seeing more pregnant women who are considering cannabis. The most common reason I see that women want to use marijuana during pregnancies for nausea or issues with appetite especially in the first trimester Lena is with university of California, Los Angeles health. She says patients ask her questions about the safety of edibles, CBD lotions and all sorts of other products Californians can buy now, she says current research hasn't even taken into account the higher potency levels. We're seeing now or the different ways people can ingest cannabis in the absence of solid data. Lena says she has to tell her patients to stay away from it all to be honest. Most patients will still continue it by me telling them that. But I think they're so miserable that they're looking for anything that can help them feel a little better. But while dot. Doctors are telling their patients to abstain a lot of women are turning to each other for advice both in person and on social media. Another woman I spoke with lives in West Hollywood. I'm calling her S for her first initial she recently gave birth to her second child s runs an anonymous Instagram account where she writes about cannabis and being a mom, her posts, usually get hundreds of likes and comments. There's so many women who have sent me direct messages in who have emailed me and told me that late. I smoked weed for like, both my pregnancies and my kids are join just fine and they're seven and nine now while that's not clinical research for these women. It's a community where they don't feel judged for me. It's just like, well, why would you lie about that? Because like, I wouldn't tell anybody that especially if you're not in a state, whereas legal be uncertainty around the galaxy makes research and answering safety questions hard Daniel Piomelli as a professor at university of California Irvine and directs the school. New center for the study of cannabis. I think what we need to understand is if there is a level above which kind of is becomes seriously problematic and the result before which kind of is still not problematic. Danielle says to be clear he also wouldn't recommend that women used any kind of marijuana while pregnant or breastfeeding, but he also says researchers like him have a duty to find out if women are going to use are there, safer ways. Those are questions he hopes to answer. This is a harm reduction aptitude that I think has really lacked in the past because what prevailed in still I think a little bit psychologically prevails is the idea of say no Danielle says any definitive answers are still potentially decades away. That's Michelle Loy. She's a reporter at KCRW. Her story was produced as a project for the USC Annenberg center for health journalism twenty eighteen California. Fellowship. We're talking about marijuana all of the new questions and issues that are popping up as attitudes and laws are changing at a rapid pace. I think there are some idea out there that because we're legalizing it. It means that it faith when we we really don't know. That's the case. That's Karen Wilson. She's a professor of pediatrics at the Icahn school of medicine at Mount Sinai in New York City. She's been researching the health impacts of secondhand tobacco smoke on children for years. We noticed that more and more parents were saying, oh, no, I don't smoke tobacco anymore just marijuana because it's natural. And at that point, we all realize that marijuana was becoming normalized even more so than tobacco, and we are quite concerned that as we moved into legalization that would mean that more children would be exposed to second hand marijuana smoke. Karen says at this point we still don't know very much about the health impacts of second hand marijuana smoke on chill. Children does it irritate their lungs. Could it affect issues like asthma in one study? She found almost half of children whose parents smoke marijuana tested positive for lower levels of THC and some of those kids would have tested positive in a drug test. And what does that mean does that mean that they felt the psychoactive effects of marijuana? Or does it just mean that they were in the presence of it? It just means they were in the presence of it. We really don't know anything about how they are experiencing this. We don't know if children are more susceptible to the influences, or maybe they're less susceptible to the influences. There is no data on that part of what has made this difficult is that in many cases being exposed to marijuana smoke is still reportable to child protective services, and so doing research and being able to identify families where this is occurring can. Can be really problematic and in all of the cases when we've studied this. We've done this anonymously. So we can't go back and link those results with any specific patient, which makes it much much harder to do the kind of long term follow up studies that we would need to do to be able to understand the true effects of this children. Karen Wilson is a professor of pediatrics at the Icahn school of medicine at Mount Sinai in New York City. Medical marijuana is becoming so much more available, but many of the ground rules are still unclear who benefits from it who should take it. And for what does it have a role at all in pediatrics back in two thousand nine Marie Myung Oakley noticed a change in her son. He has autism and his tantrums suddenly started to escalate after he turned nine he was having a lot of violence. He was hitting people. He was hitting himself. He would be destructive in her house. He destroyed a lot of things, you know, towel bars were bent walls had dents in. And he also most disturbingly started to eat his clothing. This is an eating disorder called pica where people eat things that are not food. Jason's paiko was so severe. That he would eat basically his entire shirt on his bus, ride home. So by the time, he got home he would come off the bus bare-chested, and that also caused more digestive problems. And then he wasn't eating his much in that attitude. This behavioral spiral Jason was also aggressive at school biting spitting headbutting somedays, his teachers counted three hundred aggressions he is mostly non verbal so marine knew that talk therapy was not an option for her son. She consulted Jason's doctor looked into all kinds of medication options and their side effects. And then she started to think about cannabis that with cannabis maybe we could do a bunch of things at once, you know, he had anxiety. He had sensory overload. He might have got pain. A lot of times when he would do very extreme self harm like hitting his head on our cast, iron bathtub. I just felt really it wasn't a behavior. I just felt instinctively that he was a lot of pain. And I kind of felt if I was in a lot of pain, and no one was helping me what would I do? And I almost felt like this is what I would do, you know, I would try to hurt someone to get their tension or add hurt myself to distract myself. But Maria was still not a hundred percent convinced that this was the right way to go. I was thinking how crazy this seemed at the time. Also, you know working as a professor and trying to be apparent in. Here. I'm contemplating giving my son marijuana. She talked to medical marijuana patients worked with Jason's doctor and eventually Jason became the youngest person in Rhode Island registered in the states medical marijuana program, but Maria still needed to figure out the best drain. She experiment. Rented trying different kinds making cookies and tinctures the first time he had any kind of cannabis he stopped eating his clothes. So that was one of the sort of big shots in the arm. We got right away that was very motivating to try to continue and figure out like how do we do this eventually after about a year of trial and error? They landed on a strand called white Russian. It's a favourite with cancer patients with extreme pain. And there was something about Jason system that came into balance because it wasn't as you have. He was high at all it was just he suddenly wasn't in pain, and we hadn't seen him smiling for at least a year. And so suddenly he's smiling. Again, he was finally able to learn to ride a bike. Jason started doing better in school his aggressions went way down, but he's still struggled during mealtimes. He would throw his food around when we were probably about six. Six months into our cannabis journey. I decided I was going to try to give him this Korean soup that used to love, and it's called ten John to get Marie was worried that Jason fling the bowl across the room. But she wanted to give him a chance. She left the kitchen and let Jason eat his soup by himself. My husband, and I were kind of huddling waiting, and we just heard little ding ding, ding noises from his spoon hitting the ball. And then we heard just some weird other clattering noises water we didn't kind of understand what was going on. So then when he came out of the kitchen, we went in and saw that he'd not only eaten his soup, but he'd rinsed his pole, and he put the ball in the dishwasher, and this this entire time. We were realizing, you know, we've never had him do that or shown him. How this is what you do after you eat. But that even in his worst times when he was having tantrums. He must have seen. That's what you do when you're done eating. And I have to say that was one of the highlights of being a parent seeing how wonderful was that. He has been observing us all this time and had and does want to be helpful in that moment. I just felt so much that I was seeing my son and that he loves me. And that he he wanted to clean up after sort of show me, look, mommy, I know how to do this recess cannabis isn't a miracle cure. But it did help balance Roussin than a way that allowed him to function better Jason is nineteen now and cannabis isn't as central to his therapies anymore. But Marie says he's still overall a happy kid. That's our show for this week the pulses of production of WHYY in Philadelphia. Our health and science reporters are Allen you Liz tongue jet sleigh meant and Steph yen. We had production assistance from Julian Harris and Claire struggle from K H NS in Haines, Alaska. Charlie Kyler is our engineer Lindsey Lazar ski is our producer. I'm Tanya English is our editorial director, I'm Mike and Scott. Thank you for listening. Behavioral health reporting on the pulse is supported by the Thomas, scattered good behavioral health foundation, an organization that is committed to thinking doing and supporting innovative approaches in integrated healthcare WHYY's health and science reporting is supported by generous grant from public health management corporations public health fund, P H M gladly supports WHYY and its commitment to the production of services that improve our quality of life.