Parents raising children in the United States may have many concerns about their children's substance-related matters. Alcohol, tobacco, coffee, marijuana, also known as cannabis or hashish, are some of the things I would like to talk about. Hello, everyone. I am Dr. Susan Chung, a psychiatrist. In Korea, before this, I lived in the countryside near Sanseong-ri, and all the neighbors would come to our house. They would lay down a big stone and listen to the radio there. So, they used to smoke yukmocho together back then. But when I came to the United States, the smell of marijuana was so strong. In the past, I used to go to a wrestling gymnasium and the smell was like that of yukmocho. The smell of marijuana, or what we call yukmocho in Korean. That person was saying that many people smoke marijuana here, so the smell of yukmocho was the same smell of marijuana.

The plant's name is cannabis sativa, commonly known as marijuana. This is not just anywhere that marijuana's essence comes out. And it only comes out in the female plants, not in the male plants. I apologize. It only comes out in the female cannabis plants. So, when the flower blooms, the resin comes out right below the flower. They collect that resin and use it to make THC (Delta-9-tetrahydrocannabinol), which is the extract of marijuana. The most widely used substances in the world are, as I mentioned earlier, coffee, alcohol, and tobacco. The next most widely used substance by people worldwide is marijuana. Since 8,000 years ago, in India, China, the Middle East, and Asia, it was not used for recreational purposes. Generally, it was used for its fibers or for medical purposes, although I'm not sure what specific illnesses it was used to treat. Nevertheless, it seems that when Napoleon returned from Egypt, soldiers brought it with them.

So, because the soldiers brought it, it spread to Europe. In England, a surgeon who worked in India brought it with him. It was used for medical purposes at that time. So, it entered England, and later, around 1930, it came to the United States from Mexico. Jazz musicians in the United States probably started using it around that time. That's why when you use it, you hear different sounds with a slightly different accent. Musicians seemed to like it. Therefore, in the United States, it was made illegal in 1938 because it had many different side effects. Nevertheless, despite that, the 1970s was a time when there were many hippies. In the 1980s, it was used quite a lot, and in the 1990s and 2000s, it decreased a bit. I completed my general psychiatry, child psychiatry, and adolescent psychiatry from 1974 to 1977 at Tulane University in New Orleans during the 1970s.

The head of our psychiatry department was Dr. Heath, and he had very rapid thinking. He said that many mental illnesses are caused by the brain. He was not just a psychiatrist but also a neurologist, combining neurology and psychiatry. He did a lot of research and was globally famous. One of his studies involved inserting long needles into the brain, and depending on how it was done, the patient could experience various things without anesthesia. They would insert the long needle, and what happened? Sometimes they would cry, and sometimes the patient would be extremely happy. Sometimes they would experience orgasms, sexual orgasms, I mean. It depended on which part of the brain it was done in and where it would manifest. So, the brain is considered the Brain Decade of the 1990s, right? But this person was already in his 70s has been studying the brain 20 years ago. Anyway, this person was heavily involved in studying the brain. In one experiment,

they divided monkeys into two groups. One group of monkeys was continuously exposed to marijuana. They were given marijuana and made to smoke it repeatedly. Then, after some time had passed, the brains of the monkeys were autopsied. Based on this, the person discovered that even though people were saying marijuana had no problems in the 70s and 80s, it actually caused issues in the brain. After that, more usage and different levels of usage occurred, of course, and in this case, a lot was given. Even today, many people use it more than five times a day, and starting from a young age increases the probability of addiction. So, how is hashish or hash oil made from marijuana? As I mentioned earlier, the important component is THC (Delta-9-Tetrahydrocannabinol). Delta-9-Tetrahydrocannabinol is the most important substance. Marijuana is made by collecting the extract of marijuana buds, and it contains about 0.5-5% THC.

If the concentration is increased to about 3% to 8%, it becomes hashish. And if it is further concentrated and added to oil, it becomes more potent at 20% THC and is called hash oil. This marijuana is fat-soluble, not water-soluble. So, it remains in the body's fat tissue or even in the brain's fat tissue. Therefore, there are cases where it remains there. So, how is it used? There are three methods. First, you can smoke marijuana powder either mixed with tobacco or without tobacco, rolled in paper like a cigarette. The reason tobacco is added is that it helps the marijuana burn better. So, you can use tobacco along with it or not.  The next method is for those who want to consume a large amount at once. It's called a bong, which is a water pipe. You use a water pipe to inhale a large amount of smoke through a pipe. Since it goes directly into the lungs, the effects are felt very quickly.

Nowadays, isn't there a trend of making edibles, like adding hashish to brownies or cookies? But kids consuming these edibles have become a problem in many cases. Now, in Colorado and Washington state, it has already been legalized since 2012. So, there might be many such products being produced there. And as I mentioned, marijuana ranks among the top four substances with the highest prevalence worldwide. In the United States, 42% of the population, ages 12 and older, has used marijuana at least once in their lifetime. And between the ages of 12 and 17, about 17% have used it, which means one in five people. After that, the highest usage occurs among adults, ages 18-25, possibly to signify that they are adults. 51% said they used it so that shows that more than half of the population have used it. However, the usage decreases among adults aged 25 and older. 44% said they have used it.

These statistics represent the prevalence of having tried marijuana, not necessarily regular usage. This has been extensively studied pharmaceutically, and doctors like Dr. Heath have conducted numerous research studies. When we consume marijuana orally or inhale it through the nose, it needs to bind to receptors in our body. There are two main types of receptors: one in the brain, of course, and the other in the immune system. In my opinion, people might have used marijuana 8,000 years ago because if the immune system had receptors, it would have helped when diseases or infections entered the body. So, it might have had medicinal effects. However, nowadays, people use it mostly for pleasure, which affects the brain. When it reaches the brain, it enters the fatty tissue because the brain has fatty tissue, allowing it to adhere well. This receptor is called the number one receptor. But where does it predominantly bind? It binds near our memory center, the hippocampus, which is responsible for short-term memory.

So what happens? Memory decline. Furthermore, in our brain, the prefrontal cortex is responsible for logical thinking, judgment, and emotional regulation. But this entire prefrontal cortex is mostly composed of motor neurons. So, when marijuana binds to these neurons, what happens? Motor function becomes impaired. Reaction time slows down, and behavior, and walking can become abnormal. But don't these people drive? That's when traffic accidents become more likely. Since their motor function is affected, it increases the chances of accidents. So, in my opinion, traffic accidents are quite common due to these individuals. How is Colorado and Washington state doing right now?
The federal government allowed their use in 2012. Oregon and Alaska also received permission around that time, in 2014. I believe California also legalized it afterward. So, basically, because people demanded it to be legally permitted, there was no way to stop it. Look at how much of a problem alcohol is. But because people wanted it, it couldn't be prevented, right?

So instead, the government regulates by putting an age restriction of 21 years old. When we have marijuana and we smoke it like a cigarette, in 10 minutes it goes to the blood and brain, so it has a calming effect. And usually, if you wait for about an hour, about 10% to 20% remains, and the rest is eliminated from the body. Some people do it more than five times, while others do it all day long. This is because if it disappears after an hour, they do it again, and this cycle continues. These people, in my opinion, have more problems than those who simply smoked cigarettes. Instead, they make brownies or cookies by adding hashish. Now they consume it orally, so the effects don't show up immediately. Like any medication, it takes about an hour or three for the effects to manifest, and then it gradually increases, leading to various psychological or behavioral effects. Sometimes it can last for 28 days.

a month, because it can stay in the body's fatty tissues. And an interesting thing is that it alters perception. So, when you experience something, the sensation is different. That's why when you have sex, the sensation is much more heightened. That's why young people do it a lot, and even gay individuals engage in it frequently. As a result, many engage in risky behavior without protection. Now, that becomes a problem. So, ordinary experiences become more special with marijuana. When people eat it or watch TV while under its influence, it intensifies their experience. That's why they gather in groups and do it a lot. Young people then become more talkative, more sociable because they keep talking and socializing with others. When making friends, it might even help with sociability. So, if they continue like this, they end up laughing a lot for no reason. Even if something isn't funny, they still laugh, and the group parties. With high-potency marijuana, they are volunteers to give it to college students, encouraging them to use it more.

So, by giving them money, they greatly increased marijuana use. Then, people start experiencing hallucinations. They hear strange sounds and see strange things. And suddenly, they have delusions. Delusions like someone is chasing them, or they believe they are a great person at a certain university, or various other delusions. This increases delusional thoughts, which are false beliefs. This is what we call schizophrenia. If it comes from conditions like bipolar disorder, it doesn't get cured. But even in people who didn't have these conditions, they develop these symptoms when they use marijuana heavily. That's why researchers have discovered that if someone who had conditions like schizophrenia used marijuana a lot, the likelihood of developing such a condition is quite high. They say these things, and then people who had their conditions relatively under control with medication, when they use a lot of marijuana, it can worsen their condition. Even in normal individuals, they can experience delusions and auditory hallucinations. Aren't those symptoms of schizophrenia?

So, in my opinion, this is not a substance that has no problems. It seems to be a very dangerous substance. I'm really scared of schizophrenia, because there's nothing like that. And one becomes more anxious when using marijuana. As I mentioned earlier, initially, it brings a sense of peace and a good mood within 10 minutes, but that's not the only effect. I've seen a lot of cases in the emergency room where people used marijuana for the first time and started feeling strange, anxious, not knowing what to do. Some say it's because there was another factor involved. However, for first-time users, they don't know what they are ingesting so they feel anxious and sometimes they experience panic attacks as well. They also worry if they're going crazy. Then they can become depressed. So, this is not an easy drug. After using it, some people experience postural hypotension. When they sit still, it's fine, but when they suddenly stand up,

especially if they were lying down, and then suddenly stand up, their blood pressure drops suddenly. This can cause them to faint or even get injured. Especially when their exercise capacity is reduced, right? So, you have to be careful about that. That's why they can fall. So, low blood pressure can occur. And now, feeling anxious like this, some people experience heart failure. So suddenly, they can die. That's why many of these patients are brought to the emergency room. So, please don't think of it as a very easy substance. As I said before, The effects and withdrawal symptoms of using something are always opposite, right? Now, when it comes to marijuana, if you use it moderately, as I mentioned before, it brings about a sense of peace and a good mood. It makes you feel relaxed, and even when you listen to music, it feels more vibrant and lively. However, when you decide to quit and experience withdrawal, the opposite effects occur.

It makes you anxious because the relaxation you felt is now gone. I have seen many patients with bipolar disorder who refuse to take their medication because they believe they can endure without it. They have many grand delusions. Now, these people come to me and ask for something specific: prescription medical marijuana. They ask me to prescribe it for them, but I respond by saying that since I don't know how to use it, I can't provide it. If I say anything else, we end up arguing. I can't give my patients a medication that I haven't tried and don't have personal experience with. I need to know through experience. That's why I usually didn't prescribe it. However, now that I know marijuana helps me sleep so well, if I stop using it, I won't be able to sleep, and instead become anxious. Some scholars suggest that marijuana, if used excessively and continuously, can reduce motivation. They call it amotivational syndrome. To investigate this, between 1972 and 1973 (my training was between during 1973 and 1977), a study was conducted in New Zealand.

Over 1,000 young individuals, 13-year-old children, were categorized into those who used marijuana heavily and those who didn't use it at all. An IQ test was administered. They were monitored them for 25 years, and when they turned 38 years old, they took another IQ test. Can you guess the difference in IQ test results? It likely didn't show improvement, did it? Of course not. Their memory didn't improve, and they didn't think about studying, so their grades dropped. We talked about grades earlier, that 1/5 drop out of school. This is about IQ. It's the ability to exercise intelligence in the prefrontal cortex, which we inherit from our parents. It dropped 18 points. It's a frightening consequence. Someone with an IQ of 100 will drop to about 80. But an IQ below 80 is considered borderline mental retardation. An IQ of 80 to 120 is considered relatively normal. If a person who had an IQ of 80 continues to use this and goes down by 18, he will be about 60.

It indicates a significant decline in intelligence. So, it's a serious problem. And when these young individuals use drugs, for example, I had a 9-year-old patient who would take his father's alcohol in a thermos and bring it to school. He would go to the mountains during lunch break and drink it. He was caught doing that. This is how it goes. These children engage in such behaviors at a very young age. After consuming alcohol, they go to the bathroom to smoke cigarettes. And after that, they move on to marijuana. Once they start using marijuana, they may progress to using amphetamines, followed by stimulants, then followed by hallucinogens like LSD, and then amphetamines, and then opioids and cocaine. Marijuana is the gateway drug to the use of other harmful drugs. Some people, after using it, claim to experience sudden feelings or flashbacks a few days or weeks later. That's what they call a flashback. In my opinion, if you observe closely, you'll realize that not everything leaves the brain right away; it remains there.

So, I believe it's not just a purely psychological flashback, but there may also be some material aspects to it. However, I didn't come across such information in the textbooks I've read. Among those who use marijuana heavily, there is a higher incidence of testicular cancer. To conduct lab tests for this, it can be done through urine and blood tests, but the hair on the head, pubic hair, and hair around the genital area can also be analyzed. Surprisingly, the amount of marijuana in the hair is often higher. I don't know why that is. Additionally, traces of marijuana can be detected in sweat and saliva, and it can even appear in urine up to 10 days later. Furthermore, since marijuana is stored in fatty tissues in the body, it takes longer to be eliminated because it resides in the adipose tissue. That's why during withdrawal, as I mentioned before, people often experience intense anxiety and feel unstable. Due to these symptoms, they become depressed, and in order to treat the problem, antidepressant medication is often prescribed at that time.

Many people advocate for medical marijuana and request it from doctors. They ask for it to be used for medical purposes, particularly for cancer patients. When these individuals receive cancer treatment, they often experience nausea and vomiting. When experiencing nausea and vomiting, using marijuana can help alleviate those symptoms. Additionally, there are other situations when it is used. Marijuana greatly stimulates the appetite, so HIV/AIDS patients, whose appetite is significantly reduced, may find their appetite increased when they smoke or consume it. Therefore, it is used in such cases.
Furthermore, there are peripheral neuropathies. Among them, the most representative one you may have heard of is multiple sclerosis (MS). It is more common in women, and in the past, it was mistakenly misunderstood as hysteria. The nerves themselves are not the main issue, but the outer layer surrounding the nerves, known as myelin, which is like a cloth-covered wire in a circuit. When this myelin is damaged, it causes problems, leading to multiple sclerosis. One type of multiple sclerosis is amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.

ALS affects the muscles and leads to respiratory difficulties after a while. It involves the loss of the covering that surrounds the muscles. A person with ALS can have it for 3-4 years. In this case, the nerves themselves are fine, but the covering around them becomes the issue. Multiple sclerosis usually affects two peripheral nerves, and the one that goes to the eyes can result in sudden vision loss. However, since the nerves themselves are still present, the vision can return. Therefore, in the past, doctors mistakenly attributed it to hysteria. Additionally, there are times when suddenly the legs, which were functioning normally, cannot be used. This is because inflammation occurs in the nerves going to that area. That's why there are quite a few MS patients around me. So, on some days, they walk around with a cane. When giving this to people with multiple sclerosis who have peripheral neuropathy, it helps alleviate the tingling sensation, lack of energy, and severe exacerbations. It also provides some pain relief.

It is similar to using 60mg of codeine. Therefore, it would be very helpful for cancer patients who experience pain. As for the vomiting issue we mentioned earlier, I previously mentioned Sativex, which is extracted from marijuana. When withdrawal symptoms are severe, I mentioned giving it. However, Sativex doesn't contain any components that induce pleasure, and nowadays people often use CBD oil because it only has the effects of CBD. When muscles suddenly have spasms or contractions, causing them to collapse, it can be used extensively for multiple sclerosis patients. This drug is still not used in the United States, but it is used in Canada, Europe, and the United Kingdom. It is also said to be helpful for epilepsy patients. Additionally, there is glaucoma, which is an increase in intraocular pressure in the eyes. In some aspects, it can help lower intraocular pressure for about 3 to 4 hours. I'm referring to Satidex. People often say that their child's scent seems like they have used something, but how can you know it's not them?

When using marijuana, the most noticeable effect that usually appears within 1 to 2 hours is the redness and congestion of the pupils. However, consuming alcohol can also cause some redness, but conjunctival congestion caused by marijuana has distinct characteristics. If a child engages in unusual behavior around 2 to 3 a.m., experiences sudden increased appetite, and uses more liquid than usual, it may be due to using drugs. They may also have a dry mouth and an increased heart rate. These are the four main effects that occur with heavy usage. The withdrawal symptoms I mentioned earlier include extreme anxiety, not only anxiety but also increased anger and aggression. It becomes dangerous, because can they attack. It also causes anxiety in the nervous system. Furthermore, they used to sleep well, but now they can't sleep. They experience insomnia and when they do sleep, they have disturbing dreams. After that, even though their appetite was good before, it decreases significantly, leading to weight loss. They become restless, depressed

and experience abdominal pain. As you can see, it affects the nerves significantly. They can't stay still and feel shaky. In some cases, they may experience seizures and headaches. So, due to the difficulty of withdrawal, some people continue using it, but in such cases, using something like Sativex may help reduce the severity. However, it seems that Sativex is not yet available in the United States. I talked about marijuana today. If you found the information helpful, please like and subscribe to the channel, and don't forget to set the notification. Thank you and goodbye.

Cannabis-Related Disorder I 대마초 중독 I 대마초를 사용했을 때 나타나는 증상들 I 정신과 의사 수잔 정

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