Okay, now, on to the million dollar question. How harmful is cannabis really?
I may have said in earlier lectures that I felt that cannabis was more worrisome
and more dangerous than other drugs.
Some people may say that there's no danger to these drugs.
So, when we take a look at certain respected journals and they take --
and they try and determine where the harm is coming from, it's a difficult thing to quantify
but I think it's fair to say that the most harm in society is coming from alcohol.
You could argue that the next three are heroin, cocaine, and methamphetamines.
Methamphetamines being particularly worrisome in the United States.
Cocaine as opposed to the crack cocaine shown higher in the graph is also a significant concern
but to be perfectly honest, we haven't seen a lot of major crashes
with patients on cocaine in our emergency departments as we have the other ones.
If you considered tobacco a drug, it's definitely on the list.
I would sometimes argue that tobacco is worse than alcohol,
but really, it depends on how you define you parameters.
Then, you have the amphetamines and finally, you have the cannabis.
Other products are less than that. Now, this is the harm to users.
This isn't really a harm to society kind of a graph
but it does show that cannabis as a general rule are not as bad as some of the other drugs.
So, it is considered a soft drug. However, we also have to take a look at cannabinoids
and decide if it's a good drug or a bad drug.
Now, from a pharmacology perspective,
let's ignore the politics of cannabis. Let's ignore the hype around it.
Let's just talk about a good drug versus a bad drug.
From a pharmacology point of view, a good drug is one that is water soluble.
So, it loves water, hydrophilic. A bad drug is one that is lipid soluble or loves lipids or lipophilic.
A good drug is rapidly metabolized. A bad drug is slowly metabolized.
A good drug has very localized receptors in the brain and it works in a very specific area.
Say, for example, the antidepressants.
If you look at my antidepressant lectures, I start off from the most broad kind of worst antidepressants
and I moved to the more specific ones that have fewer side effects and are more effective.
A bad drug on the other one has very generalized effects in all kinds of tissues.
It could be all kinds of tissues in the brain, in multiple areas with multiple receptors.
It could even have receptors in the stomach, in the bowel, in the kidney, whatever.
So, if there's lots of receptors all over the body, that drug that's affecting those receptors could be defined as a bad drug.
Another aspect of a good drug is that it's very specific to a very small number of receptors or even receptor subtypes.
So, it's not just something that acts on the opioid receptor but it acts specifically on say the mu opioid
or the kappa-opioid receptor only and it doesn't act on a whole bunch of different receptor subtypes.
A bad drug on the other hand is active against multiple receptor types.
It can be active against serotonin. It can be active against the cannabinoid system.
It can be active against the opioid system. That's a bad drug.
A good drug will have few active compounds in the product.
So, if your product has one, single, pure product, it's a good product.
If your product has many active compounds in the product, I would consider it a bad product.
So, when we start talking about cannabinoids,
we want to say that really, every single one of the criteria on the bad drug column
is being fulfilled by the cannabinoids.
It is lipophilic, it is slowly metabolized, it has ubiquitous receptors all over the brain
and in fact, even in the stomach and other organs, it is active against multiple receptor subtypes
and there's many active compounds in cannabinoids.
There could be hundreds of active compounds in a joint.
So, we really have to be aware that by every single criteria that we use in pharmacology, cannabinoids are bad news.