Heavy Use

The Effect of Chronic Cannabis Use on Volumetric Alterations in Brain Regions

Title: Neuroanatomical alterations in people with high and low cannabis dependence

A recent article has been published revealing some volumetric alterations in specific brain regions in people who report dependence on cannabis. Magnetic resonance imaging revealed that the volume of certain regions, including the hippocampus, the cerebellum, and the caudate, in cannabis dependent users, were all reduced in size, relative to recreational cannabis users who did not use cannabis chronically. Future research will likely focus on the effects of the structural alterations on patients’ reward, stress, and addiction-relevant circuitry to examine the possible relevance of cannabis dependance on those circuits. 

There are certainly possibilities that suggest this volume difference could be of concern, but there are also a great number of explanations (more than likely) whereby this is related to another variable that we have not yet fully appreciated.

Currently, cannabis use is thought to have a little-to-no risk of addiction (beyond any “normal” product of medical value, such as coffee or eyeglasses), because it does not act directly on the reward circuit. Opioids have a high risk of addiction, and therefore a concerning safety profile, in part because of the direct effect of the opioid system on the reward pathway of the central and peripheral nervous systems. While the endocannabinoid system has been observed to act directly up the reward circuit, it does so in subtle, soft ways, making it an ideal adjunct therapy for opioids to help with pain management. Current research provides inconsistent results and appropriately emphasizes a need for more testing to validate the possibility of cannabis as a recommended pain medication. 

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Benjamin Caplan, MDThe Effect of Chronic Cannabis Use on Volumetric Alterations in Brain Regions
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The Effect of Cannabis Consumption on Sperm

Impacts of cannabinoid epigenetics on human development- reflections on Murphy et. al. ‘cannabinoid exposure and altered DNA methylation in rat and human sperm’ epigenetics

An op-ed has praised the work published last year which exposed how pre-conception exposure to cannabis in males is related to alterations in epigenetic regulation of the central nervous and immune systems. Murphy et. al.’s paper ‘Cannabinoid exposure and altered DNA methylation in rat and human sperm,’ revealed that the sperm cells of men who have consumed cannabis are a key vector that may affect neuraxis, heart blood vessels, immune stimulation, secondary genomic instability, and carcinogenesis in the fetus offspring. The author of the response piece extrapolates the data collected by Murphy et. al. to conclude the genome-epigenome is extremely sensitive to environmental toxicants and that further research should examine the epigenomic toxicology of multiple cannabinoids. 

The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is still uncertain. Studies focussing on cannabis use during pregnancy are limited, and what little has been reported, is inconsistent. The featured article now brings to light that both parents may need to be cautious when attempting to conceive or when having unprotected sex as cannabis may affect both germ cells. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use so if someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

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Benjamin Caplan, MDThe Effect of Cannabis Consumption on Sperm
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Cannabis: Vaporizing vs Smoking

Smoking cannabis brings toxins and unhealthy combustion byproducts into the body. With temps in the ~2000’F range for flame, burning flower incinerates a large portion of the product being consumed. As the distance from the point of flame grows, temperatures are lower, and cannabinoids are vaporizing, in addition to being burned by the flame. Over time, as heating technology has improved, there is no longer a need for blasting temperatures way beyond what the material can safely sustain before turning to tar and ash.

Beyond developed habits of consumption, social familiarity, and simplicity of use, one of the reasons many enjoy combustion is the other effects of heat. As with any human contact with extreme heat, blood rushes to the source of heat, and this may present a platform, through which cannabinoids may enter the bloodstream more quickly. The extravagant heat is also aerosolizing many more cannabis compounds than vaporization temperatures typically support, so the effect of flame is often felt to be more intense.

Vaporizing cannabis, however, is less likely to introduce mutations in the polyphenol compounds found in abundance within cannabis, and some of the mutations create terrible molecules known to be caustic and destructive.

If the medical rationale for vaporizing (over combustion) is not convincing, please consider the financial argument: Though purchasing a vaporizer may be costly, it’s a smart investment that could save money in the long run. Learn more by watching this video:

Benjamin Caplan, MDCannabis: Vaporizing vs Smoking
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Can specific, isolated Cannabinoids reduce Cannabis Dependency?

Using cannabis to decrease dependency on cannabis? An Australian study shows promise using Nabiximols to target receptors and diminish the rate of relapse. The spray of equal parts CBD and THC had regular smokers smoking 19 fewer days than those on placebo

The News article: http://bit.ly/2YbSrN1

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Benjamin Caplan, MDCan specific, isolated Cannabinoids reduce Cannabis Dependency?
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Student-Athletes are at an Increased Risk for Binge Drinking and Substance Use

Title: Psychological correlates and binge drinking behaviours among Canadian youth- a cross-sectional analysis of the mental health pilot data from the COMPASS study

A recent study has examined data from the COMPASS program and found that student-athletes in Canada were more likely to engage in binge-drinking and illicit substance use. Researchers focussed on the measure of flourishing, defined as an overall healthy mental state and emotional connectedness, and how flourishing related to concerning drinking and substance use behavior. Student-athletes were found to be the most at risk for binge-drinking, defined as consuming 5 or more drinks in a single session, and those more likely to binge-drink were also more likely to co-use illicit substances. This research provides evidence for the formation of targeted prevention programs.

Cannabis use is banned among athletes by most sports organizations. Cannabis appeals to athletes considering the many different consumption methods, allowing discreet consumption and personalization with variable potential opportunities for relief. Cannabinoids are generally naturally occurring substances unless clearly manufactured, and have been shown to be beneficial for post-workout recovery, muscle soreness, anxiety, sleep, and relaxation. All of those symptoms, including the emotionally driven ones, are common among student-athletes who often feel an immense amount of pressure to perform in competition. As in most other areas of modern culture, Cannabidiol (CBD) finds itself in a grey area for most sports organizations’ substance regulations given that it is not intoxicating and readily available with a notable safety profile. Even if cannabis is not federally legal, CBD is so widely available that many athletes are embracing it, in lieu of more dangerous, or potentially addictive, medications.

Tweet: A recent study has examined data from the #COMPASS program and found that #studentathletes in Canada were more likely to engage in #binge-drinking and illicit substance use. Read this and other linked studies:

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Benjamin Caplan, MDStudent-Athletes are at an Increased Risk for Binge Drinking and Substance Use
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The Endocannabinoid System’s Effect on the Cerebellum is a Drawback for Anti-Inflammatory Meds

Title: Monoacylglycerol lipase blockade impairs fine motor coordination and triggers cerebellar neuroinflammation through cyclooxygenase-2

Researchers are constantly considering how cannabis may impact the human brain, for better or worse. A recently published work points out a negative effect on the cerebellum, caused by the inhibition of the main enzyme that is used to break down the endocannabinoid “2- arachidonoylglycerol” (2-AG). By inhibiting the degradation of 2-AG, more of the endocannabinoid is allowed to remain in, and act upon, the human nervous system. This abundance of 2-AG results in reduced synthesis of prostaglandins, which produces an anti-inflammatory effect.

Unfortunately, the abundance of 2-AG also results in motor coordination deficits related to the effect on the cerebellum, but the addition of a cyclooxygenase-2 (COX-2) inhibitor (commonly found in many over-the-counter anti-inflammatory medications) reverses these cerebellar deficits. 

This highlights the far-reaching capabilities of the endocannabinoid system and at least one powerful angle where researchers could develop medications to indirectly impact the endocannabinoid system. Cannabinoids are still a politically hot topic, but synthesizing drugs that alter the level of endogenous cannabinoids available in the body is an ideal way to study the endocannabinoid system and its therapeutic benefits, without engaging with the red tape that surrounds cannabis. The receptors mechanisms for the endocannabinoid system certainly warrants further investigation.

Tweet: Researchers have recently revealed the negative effects on the #cerebellum caused by the inhibition of the main enzyme utilized for the degradation of the #endocannabinoid 2- arachidonoylglycerol (#2-AG). Learn more at

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Benjamin Caplan, MDThe Endocannabinoid System’s Effect on the Cerebellum is a Drawback for Anti-Inflammatory Meds
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Incidents of Driving Under the Influence of Drugs Reveals A Need for Stricter Regulations

Title: A review of drug abuse in recently reported cases of driving under the influence of drugs (DUID) in Asia, USA, and Europe

A recent literature review has found that the current driving regulations in Asia, Europe, and the US have not prevented cases of driving under the influence of drugs. The authors observed steady trends of incidences of driving under the influence in all three regions, despite legislature specifically enacted against such actions. In the literature, there is a consistent recommendation that drivers should be regularly tested, especially in the case of an accident, in order to gather more data on the role of drugs in traffic accidents. 


This review highlights the different illicit drugs that contribute to traffic accidents, depending on the region of the world. Cannabis is legal in certain areas of Europe, whereas it is still considered an illicit substance here in the US, and many other locations, worldwide. Looking at the differences in severity or circumstance of the accidents between the type of illicit drug used may provide data to create more beneficial regulations for each country. As the legal status of cannabis continues to evolve, and it becomes more common to find drivers on the road who have consumed a minimal amount of cannabis, new screening techniques will likely be developed to help the culture establish what it considers an “acceptable amount” of blood-borne cannabinoids to be.

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Benjamin Caplan, MDIncidents of Driving Under the Influence of Drugs Reveals A Need for Stricter Regulations
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