Summary
Highlights
America is ending cannabis prohibition, leading to a multi-billion-dollar industry and a social crossroads. Despite its growing legality and medical use, scientific understanding of cannabis is poorly developed. Public perception is polarized, with some seeing it as a panacea and others as dangerous, while the reality lies somewhere in the middle. The film aims to provide truth through science regarding cannabis's effects.
Many Americans, including veterans like Sean Worsley, are turning to cannabis for relief from various ailments such as PTSD. Sean's personal experience highlights how cannabis (specifically at low doses) can alleviate symptoms like paranoia, insomnia, and night terrors when traditional medications had troubling side effects. The documentary explains how cannabis compounds interact with the body's endocannabinoid system, a crucial regulatory system found in nearly every organ, influencing sleep, cognition, memory, and mood. The discovery of cannabinoid receptors and the endocannabinoid system opened unexpected windows into bodily functions, with its primary role being to maintain homeostasis. High doses of THC, however, can increase anxiety, and it's emphasized that cannabis is not a miracle cure but a tool that requires further research.
Despite cannabis being legalized for medical use in many states, it remains a Schedule One federal drug, hindering research. This leaves patients like Elizabeth Pinkham, who uses cannabis to manage chemotherapy side effects, relying on anecdotal evidence and dispensaries rather than FDA-approved, rigorously researched treatments. The market is flooded with various cannabis products, including those high in CBD, a non-psychoactive cannabinoid. However, these products often lack regulation and scientific backing, raising concerns about their efficacy, dosage, and purity, as products containing THC are generally the only ones subjected to rigorous testing.
The story of Sam Vogelstein and Ben Jacobson illustrates the desperate quest of parents seeking CBD to treat their children's severe epilepsy. Catherine Jacobson, a neuroscientist, and Fred Vogelstein and Evelyn Nussenbaum, found that CBD, which doesn't directly bind to cannabinoid receptors but can reduce THC's impact and affect mood through serotonin, showed promise. Early, unregulated CBD extracts were inconsistent. However, the consistent quality of GW Pharmaceuticals' CBD led to dramatic seizure reduction in Sam and later to the FDA approval of Epidiolex, the first CBD drug. While Epidiolex has significantly helped many, for others like Ben, it came too late, highlighting the urgent need for regulated and consistent medication and further research.
Ongoing clinical trials, such as those at U.C. San Diego's Center for Medicinal Cannabis Research, are exploring CBD's potential for conditions like severe autism. Researchers are conducting double-blind trials with children like Braylon to assess Epidiolex's impact on behavior and brain activity. Additionally, scientists like Alysson Muotri are using human skin cells to create brain organoids, which mimic developing brain activity, to study CBD's effects at a cellular level. Early findings suggest CBD can quiet electrical activity in these brain cells, potentially calming excessive neuronal activity. While promising, researchers stress the importance of robust data to confirm efficacy and long-term safety, as the amount of CBD in consumer products is often far too low to have a significant effect compared to the high doses used in medical treatments.
The impact of cannabis varies with age, particularly during adolescence when the endocannabinoid system reaches its highest levels and the brain undergoes rapid changes. During this critical developmental period, THC, which acts like a 'hammer' on cannabinoid receptors, can indiscriminately activate them across the entire brain and body. Studies by clinical psychologist Joanna Jacobus, using fMRI on teenagers, show potential links between regular cannabis use and altered brain development, such as thicker cerebral cortices, suggesting disrupted neural pruning. Adolescents who use cannabis regularly also demonstrate struggles with learning and memory tasks. However, it's acknowledged that some cognitive functions can recover with abstinence, and researchers are investigating whether these brain differences are pre-existing or caused by cannabis use through long-term studies like the Adolescent Brain Cognitive Development Study.
Research from the ABCD Study indicates concerning findings regarding prenatal cannabis exposure. Mothers who used cannabis during pregnancy, even in legal states where it's advertised as safe for nausea or insomnia, had children with a higher incidence of psychosis-like experiences, depression, anxiety, rule-breaking, and attentional problems. Scientists emphasize that the endocannabinoid system is critical for wiring the developing brain. THC crosses the placenta and binds to receptors that develop early in pregnancy. Disruption of this system during fetal development can have significant impacts, highlighting that cannabis is not a benign drug during pregnancy.
Historically, cannabis criminalization, starting in 1937, was fueled by racist narratives against Mexican immigrants. The "war on drugs," declared in the 1970s, led to millions of arrests, with severe disproportionate targeting of poor people and communities of color, particularly Black individuals, despite equal usage rates across races. The story of Sean Worsley, a veteran using medical cannabis for PTSD, exemplifies this. Despite having a medical card in Arizona, he was arrested for possession in Alabama, leading to homelessness, a stroke, and ultimately incarceration. His experience underscores how the punitive legal system often traps individuals in a cycle of poverty and further hardship, demonstrating that for many, the war on cannabis is far from over.
Cannabis is championed by some for its pain-relieving qualities, as shown by former NFL player Eugene Monroe, who found it a safer alternative to opioids for managing chronic pain. Cannabis can reduce pain, alter pain tolerance, affect the immune system, and reduce inflammation. However, daily use carries risks, with about 9% of users developing an addiction. Paul Debassio's story illustrates this, where initial use for insomnia led to dependence and severe withdrawal symptoms upon cessation, including irritability, aggression, depression, and significant sleep disruption. Research is now exploring ways to prevent cannabis withdrawal by influencing the endocannabinoid system. The narrative emphasizes that while cannabis can offer medicinal benefits, dosage, timing, and individual biology are crucial factors, and it is not universally benign.
The future of cannabis as medicine requires extensive research. Staci Gruber's ongoing study of adult medical cannabis users shows promising improvements in pain, anxiety, and sleep, along with cognitive function, possibly due to restorative sleep. However, long-term effects still need more data. The documentary highlights the societal challenges that remain, such as addressing the harms of criminalization, expunging convictions, and ensuring equity in the legal cannabis industry. The complexity of cannabis as a plant with over 400 compounds necessitates deeper scientific understanding to inform responsible marketing, potency limits, and public health policies, moving towards a science-based approach that respects individual rights rather than punitive measures.