Drugs

Scientific background information

Introduction

The module is mainly focused on cannabis (also known as marijuana, among other names), which is a psychoactive drug from the cannabis plant. An alternative pathway to be followed in this module is the scandalous substance called MMS (Miracle Mineral Drug) which is a branded name for an aqueous solution of chlorine dioxide, an industrial bleaching agent, that has been falsely promoted as a cure for illnesses, including HIV, cancer, COVID-19, and the common cold, but also autism.

In the text below, you will find explanations for the following issues:

What is cannabis?

What is MMS?

What is cannabis?

Cannabis (or marijuana) refers to a group of three plants with psychoactive properties, known as Cannabis sativa, Cannabis indica, and Cannabis ruderalis. When the flowers of these plants are harvested and dried, you’re left with one of the most common drugs in the world. Cannabis is made up of more than 120 components, which are known as cannabinoids. The two most well-known cannabinoids are cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). CBD is the second most prevalent chemical compound found in cannabis and has recently become more popular as an alternative treatment for a number of conditions. It can be derived from hemp or from cannabis. THC is the main psychoactive ingredient in cannabis. THC activates the brain's reward system by signalling the release of the brain chemical dopamine.

Figure 1: Cannabis plants

Pixabay: https://pixabay.com/photos/marijuana-herbal-cannabis-hemp-5858148/

Perhaps no other plant causes as much debate and public misconceptions as cannabis. Its usage and popularity throughout the ages has led to it being branded a super medicine by some, stigmatised as evil in society by others; and many other points of view within that spectrum. In the last decade the legalization of the drug for recreational use in many countries and largely available information on the benefits, have even increased public misconceptions. There is a large set of information available on its risks and vice versa on its benefits. Often the information is given on the Internet without proper references. Subsequently, we will look at what scientists and medical personnel have to say about the most common myths about cannabis usage referring to scientific studies.

More information about the health effects of cannabis can be found from: https://docs.google.com/document/d/1kxisOjHc0qINFXhWvmdmMAJyjp7V9JmgfWXDhCKeuyk/edit

Myths about drugs

Myth No 1: Cannabis isn’t that dangerous for health

It has been argued that cannabis is not that dangerous for health, even beneficial. This myth is widely spread, with the main explanations of other drugs being much more toxic and cannabis usage for healing purposes as an alternative drug in several countries.

However, according to scientific evidence, cannabis has been associated with many health effects (Figure 2). The most important effects include mental illness [3], cardiovascular diseases [4], lung diseases [5] and respiratory and testicular cancer [6]. Some risk groups as teens and pregnant women, are especially vulnerable to cannabis usage. Also, passive smoking is vital as cannabis second-hand smoke is very similar to tobacco smoke in terms of physical and chemical properties [7]. Moreover, cannabis use is related to addiction, it increases the risk of using other drugs, and overdoses have been reported.

Figure 2. Cannabis health effects.

Myth No2: Cannabis is okay for some youth

As many young people use cannabis, there is increasing belief that it is okay to be used. However, according to studies, cannabis use, especially during adolescence and early adulthood, can damage the part of the brain associated with learning and memory [8]. Some studies suggest regular marijuana use in adolescence is associated with altered connectivity and reduced volume of specific brain regions involved in a broad range of executive functions such as memory, learning, and impulse control compared to people who do not use [9]. Most importantly, according to studies, regular cannabis use during adolescence can lead to poorer school performance and higher school dropout rates [10]. It has been shown that the structural brain changes caused by cannabis use by adolescents and young adults are permanent – IQ points are lost and cannot be recovered with age [11]. …

Myth No 3. Cannabis is a medical drug and, therefore, safe for everybody

There are currently three more recognized uses for cannabis or cannabis-derived products: nausea and vomiting related to chemotherapy, anorexia related to advance HIV/AIDS, and a couple of rare types of childhood epilepsy [12]. All else, including psychiatric conditions, is not widely approved. Based on early data, cannabinoid therapies (containing CBD primarily) may provide a more suitable treatment for people with pre-existing anxiety or as a potential adjunctive role in managing anxiety or stress-related disorders [13]. However, certain research has also shown that it can produce feelings of anxiety, panic, paranoia and psychosis.

If cannabis is approved for healing purposes, it is most likely a specific product with fixed concentrations of specific cannabinoids such as cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) (Figure 3). Furthermore, it has been discussed that the CBD/THC ratio matters. In medicinal cannabis, it has been shown ratio plays a crucial role in improving the physical and functional well-being of brain cancer patients [14]. Only in controlled (medical) products CBD and THC concentration and doses can be controlled.

Figure 3. Cannabis and products containing certain concentrations of cannabinoids.

Myth No 4: Marijuana helps one’s mood and promotes mental health

It is well known that TBC in cannabis makes one ‘high’. This can make one feel happy, relaxed, talkative or laugh more than usual. One may find that colours and music are brighter and sharper. The exact effects on mood vary greatly from one person to another, but generally, emotions are exaggerated in a similar way to the intoxication effects of alcohol [15].

However, those “positive” effects appear short-term, whereas long-term usage is related to a large number of negative effects on mental health. Like alcohol, marijuana and associated THC-containing products are intoxicants and can contribute to impaired judgment and increased susceptibility to mental health problems, including depression, insomnia and paranoid delusions [16]. There is a significant risk of relapse or worsening of symptoms for individuals with psychotic disorders [17]. Regular marijuana use is correlated with an increased risk and/or worsening of the symptoms for individuals with anxiety, depression and psychotic illnesses [19]. There is some evidence to show a link between the use of stronger cannabis and psychotic illnesses, including schizophrenia, but the evidence is still scarce and mechanisms are not fully understood [19].

Myth No 5: Cannabis is not addictive

The myth is based on fact at of all the people who use marijuana, only about 9% will meet the criteria for addiction at some point in their lives. However, if you look at people who start using marijuana as adolescents (when the brain is still developing and is quite vulnerable), then they have four to seven times more likely to develop a cannabis disorder than adults [20]. Recent data suggest that 30% of those who use cannabis regularly may have some degree of use disorder [21].

It has also been shown that today’s strains of THC are stronger – and now produce physiological dependence and withdrawal that requires substance abuse treatment [22]. When chronic cannabis users attempt abrupt discontinuation, the signs of withdrawal syndrome – restlessness, irritability, mild agitation, hyperactivity, insomnia, nausea, cramping, decreased appetite, sweating and increased dreaming – are common [23].

Myth No 6: Cannabis is a gateway drug

Here, the evidence is undefined, and causality is not confirmed, but if we look at all the people who use other drugs, most of them have started with cannabis. Nevertheless, this does not mean that if you use cannabis, you will go on to use stronger drugs such as cocaine. But some percentage of cannabis users will do. If we compare the prevalence of cannabis with other drug users, cannabis is much more common in most countries [24]. However, based on prevalence alone, we cannot draw connections between long-term usage and the gateway hypothesis.

However, a 25-year longitudinal study has found the frequency of marijuana use to be significant with other illicit drugs of abuse and dependence – particularly with adolescent-onset use [25]. Two separate studies of twins have compared whether or not early cannabis use showed subsequent abuse or dependence on other illicit drugs. The findings showed two to five times greater risk than that of a twin who did not use marijuana [26], [27].

Another explanation of gateways and addictions is based on brain neurobiology – decreased reward sensitivity and increased expectation sensitivity overwhelm the brain's control circuit [28]. In other words, the memory circuit drives reward our expectation and enhance the motivation to consume the drug. In conclusion, the evidence is mixed, but the association seems to be there for many cannabis users.

Myth No 7: You cannot overdose on cannabis

One cannot die directly from cannabis; however, one can overdose, become physically ill (nausea, vomiting), and experience extreme anxiety, paranoia, and short-term psychosis (loss of touch with reality). These effects can take several hours to go away. An overdose of cannabis does not happen often, but the risk exists if you consume unofficial cannabis products. As usual, one cannot accurately measure your dosage and cannabinoid content. Nevertheless, as the cannabis usage prevalence in most countries is much higher than other drugs, the side effects of cannabis have led to far more emergency room visits than other substances [29].

The overdose can also result in worsening of their psychiatric condition, particularly psychosis: this reflects in paranoia, seeing things, hearing things, delusional thinking. The cannabinoid THC in cannabis can make that worse. Sometimes we end up having to give these people antipsychotic medications to reduce the symptoms and get them comfortable. The other thing people can end up in the ER for is cannabis hyperemesis syndrome (CHS) [30]. CHS is a condition caused by long-term cannabis use. People who have CHS experience reoccurring episodes of nausea, vomiting, dehydration and abdominal pain, with frequent visits to the emergency department.

Acute toxicity of recreational cannabis has also been studied in Alaska, the U.S. [31]Neurotoxicity is common after acute cannabis exposures. Children experienced unintentional exposures, particularly within the home and occasionally with major adverse outcomes. Concentrated products such as resins and liquid concentrates were associated with greater toxicity than other cannabis products. Another aspect discussed in scientific literature is medical cannabis effects on opioid overdose and mortality. Here the evidence is really mixed and recently the association have been questioned [32].

In conclusion, the association seems to be there for several cannabis users; but again, these are studies of association and the causation is not clear.

Myth No 8: Secondhand cannabis smoke is safe

As with any other type of secondhand smoke [33], the toxic substances and carcinogens in cannabis secondhand smoke can easily be inhaled by children. It has many chemicals like tobacco smoke, including those linked to lung cancer.

Secondhand marijuana smoke also contains THC, the compound responsible for most of cannabis's psychoactive effects. It can be passed to infants and children through secondhand smoke, and people exposed to secondhand cannabis smoke can experience psychoactive effects, such as feeling high [34]. Recent studies have found strong associations between reports of having someone in the home who uses marijuana (e.g., a parent, relative, or caretaker) and the child having detectable levels of THC [35]. It has been shown that infants who are exposed to secondhand marijuana smoke are at risk of sudden infant death syndrome (aka SIDS) [36].

Taking those facts, secondhand cannabis smoke causes health risks. However, several web pages frequently conclude that it is unlikely to affect people who experience limited exposure in a well-ventilated environment. Based on scientific facts, this is not true, especially in an indoor environment.

Other trusted sources

https://www.unodc.org/documents/drug-prevention-and-treatment/cannabis_review.pdf

What is MMS?

Miracle Mineral Solution, also Master Mineral Solution, or MMS, are the brand name for an aqueous solution of chlorine dioxide (ClO₂), an industrial bleach that was wrongly believed to treat diseases such as HIV, cancer and the common cold [37] [38]. Former Scientologist Jim Humble coined the name in his 2006 self-published book, The Miracle Mineral Solution of the 21st Century [39]. Humble claims the chemical can cure HIV, malaria, hepatitis virus, H1N1 flu virus, common cold, autism, acne, cancer and other ailments. There are no clinical studies to verify these claims [40] [41], they come only from anecdotes and Humble's book [42]. Notwithstanding missing scientific proof, MMS has been promoted by different persons worldwide since then.

MMS is made by mixing an aqueous solution of sodium chlorite (NaClO₂) with an acid such as HCl, citrus juice or vinegar:

5NaCl0₂ + 4HCl → 5NaCl + 4ClO₂ + 2H₂O

As a result, chlorine dioxide is produced, a toxic chemical that can cause nausea, vomiting, diarrhoea and life-threatening low blood pressure from dehydration [43]. Sodium chlorite is the primary precursor of chlorine dioxide and is toxic even if ingested [44]. High doses can cause acute renal failure. Low doses (approximately 1 gram) can cause nausea, vomiting, and intestinal inflammation, and even life-threatening in patients with glucose-6-phosphate dehydrogenase deficiency [45].

Chlorine dioxide has also been used as a drinking water disinfectant [46]. The European Commission directive [47] sets the maximum allowed concentration of chlorine dioxide in drinking water at no more than 0.2 parts per million (ppm), while the U.S. Environmental Protection Agency (EPA) has set it to 0.8 (ppm) [48].

Safety

The medical advice given is that anyone who has this product should stop using it immediately and throw it away. [49] [50] National agencies in many countries, [51] [52] [53] have warned of the effects of MMS: "MMS is a 28% sodium chlorite solution which is equivalent to industrial-strength bleach. When taken as directed, it could cause severe nausea, vomiting and diarrhoea, potentially leading to dehydration and reduced blood pressure. If the solution is diluted less than instructed, it could cause damage to the gut and red blood cells, potentially resulting in respiratory failure." More dilute versions have the potential to do harm, although it is less likely. Sellers attribute vomiting, nausea, and diarrhoea to the effect of the product, but it is actually the product's toxicity [54].

MMS is not approved for the treatment of any disease, and chronic exposure to small doses of chlorine dioxide could cause reproductive and neurodevelopmental damage.

Marketing as a “miracle drug”

According to marketers' false claims, administering the miracle solution drops will quickly "cure" many or all diseases and ailments, including cancer, AIDS, influenza, autism, etc. In marketing, the primary method is network marketing and communities close to the public in social networks. Consumer-oriented communication includes the terminology of healthy lifestyles ("eco" and the like), exploits the lack of awareness and desperation of sensitive consumers, and often also the aversion to conventional medicine [55].

Myth No 9: MMS cures COVID-19

Though there is no scientific basis for the claim that MMS can cure COVID-19 or any other disease, [56][57][58] during the COVID-19 pandemic, many earlier supporters of MMS of other illnesses, such as QAnon supporter Jordan Sather and the Genesis II Church of Health and Healing in the U.S., began touting it as a cure for COVID-19. E.g. Earlier in the summer of 2019, the Genesis II Church of Health and Healing held seminars to promote MMS in Chile, Ecuador, South Africa and New Zealand [59]. In 2020, the U.S. Attorney’s Office for the Southern District of Florida received an injunction against another church branch that specifically marketed MMS as a COVID-19 treatment using anonymous testimony and citing conspiracy theories [60]. The court issued orders to shut down all websites selling MMS, to prevent the church from creating new websites, and to confiscate all materials used to make MMS. The church was also instructed to notify customers that the product distribution had been illegal [61].

In Bolivia, officials in Cochabamba promoted MMS as a cure for COVID-19, and Congress passed a bill to authorise the “manufacture, marketing, supply and use of chlorine dioxide solution for the prevention and treatment of coronavirus”. At least 15 people were poisoned as a result [62].

Myth No 10: MMS cures autism

ABC News and KABC-TV in the U.S. investigated the MMS phenomenon in 2016 and uncovered an "underground network" centred around southern California promoting MMS as a cure for conditions including cancer, Parkinson's disease and childhood autism [63].

So did, e.g. Kerri Rivera (U.S.), who advocated for, and gave parents unsubstantiated and unprofessional medical and health advice for using MMS to “cure” autism and other serious illnesses. Later on, she was criminally charged. However, Rivera operated a Facebook page and the website that promoted dangerous MMS enemas as an autism treatment, and claimed that the intestinal lining children expel as a result is parasites (“rope worms”) [64], which was patently false [65].

More sources about MMS consumption as a medicine:

Parikh, M., Redfield, R., Wang, C., & Lautenslager, T. (2021). Miracle Mineral Solution: In No Way a “Miracle”. Official journal of the American College of Gastroenterology, 116, 832-833.