Five years ago I began a friendship with my friend H.Dale who was incarcerated because of a psychotic episode. We began exchanging letters. Since that time I have come to know him as a brilliant young man who like many of us got blind sided by a serious mental illness. Unless you’re the one who […]

The Flower of Purpose — Shedding Light on Mental Health

IDEAS.TED.COM

Sep 23, 2019 / Jeffrey Chen, MD

Is CBD a cure-all — or snake oil? Jeffrey Chen, executive director of the UCLA Cannabis Research Initiative, explains the science behind the cannabis product.

CBD gummies. CBD shots in your latte. CBD dog biscuits. From spas to drug stores, supermarkets to cafes, wherever you go in the US today, you’re likely to see products infused with CBD. There are cosmetics, vape pens, pills and, of course, the extract itself; there are even CBD-containing sexual lubricants for women which aim to reduce pelvic pain or enhance sensation. CBD has been hailed by some users as having cured their pain, anxiety, insomnia, depression or seizures, and it’s been touted by advertisers as a supplement that can treat all of the above and combat aging and chronic disease.

As Executive Director of the UCLA Cannabis Research Initiative, I’m dedicated to unearthing the scientific truth — the good and the bad — behind cannabis and CBD. My interest was sparked in 2014 when I was a medical student at UCLA, and I discovered a parent successfully treating her child’s severe epilepsy with CBD. I was surprised and intrigued. Despite California legalizing medical cannabis in 1996, we weren’t taught anything about cannabis or CBD in med school. I did research and found other families and children like Charlotte Figi reporting success with CBD, and I knew it was something that needed to be investigated. I established Cannabis Research Initiative in the fall of 2017, and today we have more than 40 faculty members across 18 departments and 8 schools at UCLA working on cannabis research, education and patient-care projects.

So what exactly is CBD and where does it come from? CBD is short for cannabidiol, one of the compounds in the cannabinoid family which, in nature, is found only in the cannabis plant (its official scientific name is Cannabis sativa l.). THC — short for tetrahydrocannabinoid — is the other highly abundant cannabinoid present in cannabis that’s used today. THC and CBD exert their effects in part by mimicking or boosting levels of endocannabinoids, chemical compounds that are naturally produced by humans and found throughout our bodies. Endocannabinoids play an important role in regulating mood, memory, appetite, stress, sleep, metabolism, immune function, pain sensation, and reproduction.

Despite the fact that they’re both cannabinoids found only in the cannabis plant, THC and CBD are polar opposites in many ways. THC is intoxicatingand responsible for the “high” of cannabis, but CBD has no such effect. THC is addictive; CBD is not addictive and even appears to have some anti-addictive effects against compounds like opioids. While THC stimulates the human appetite, CBD does not. There are areas where they overlap — in preliminary animal studies, THC and CBD exhibit some similar effects, including pain-relieving and anti-inflammatory properties and anti-oxidant and neuroprotective effects. In some early research, they’ve even shown the ability to inhibit the growth of cancer cells, but years of rigorous studies need to be conducted before we’ll know whether they have the same impact on humans.

Even though humans have been using cannabis for thousands of years, the products available today are not the cannabis that has traditionally been consumed. After cannabis was prohibited at the federal level in 1970 by the US Controlled Substances Act, illicit growers were incentivized to breed strains that had higher amounts of THC, so they could increase their profits without needing larger growing spaces. What they didn’t know was that by driving up THC content, they were dramatically reducing the CBD content. In 1995, after decades of surreptitious breeding, the ratio of THC to CBD was ~15:1, and by 2014 the ratio had jumped to ~80:1 as CBD content further plummeted.

Due to decades of research restrictions in the US and growers’ focus on THC, there are very few human studies that look at CBD and its effects. The strongest evidence we have is that CBD can reduce the frequency of seizures in certain rare pediatric disorders — so much that a CBD-based drug called Epidiolex was FDA-approved in 2018 for this purpose. There is also preliminary human data from small clinical trials with dozens of subjects that suggests CBD may have the potential to be used for conditions like anxiety, schizophrenia, opioid addiction, and Parkinson’s disease. But please note that the participants in these studies generally received several hundreds of milligrams of CBD a day, meaning the 5mg to 25mg of CBD per serving in popular CBD products may likely be inadequate. And even if you took dozens of servings to reach the dosage used in these clinical trials, there is still no guarantee of benefit because of how preliminary these findings are.

But while there is a lack of concrete and conclusive evidence about CBD’s effects, there is considerable hope. Recent legislative changes around hemp and CBD in the US and across the world have enabled numerous human clinical trials to begin, investigating the use of CBD for conditions such as autism, chronic pain, mood disorders, alcohol use disorder, Crohn’s disease, graft-versus-host-disease, arthritis and cancer- and cancer-treatment-related side effects such as nausea, vomiting and pain. The results of these studies should become available over the next five years.

Furthermore, in an effort to protect consumers, the FDA has announced that it will soon issue and enforce regulations on all CBD products. Buyers should beware because the products being sold today may contain contaminants or have inaccurately labelled CBD content — due to the deluge of CBD products on the market, government agencies haven’t been able to react quickly enough so there is currently no regulation in the US whatsoever on CBD products.

While CBD appears to be generally safe, it still has side effects. In children suffering from severe epilepsy, high doses of CBD have caused reactions such as sleepiness, vomiting and diarrhea. However, we don’t know if this necessarily applies to adults using CBD because these children were very sick and on many medications, and the equivalent dose for an average 154-pound adult would be a whopping 1400 mg/day. And while CBD use in the short term (from weeks to months) has been shown to be safe, we have no data on what side effects might be present with chronic use (from months to years).

Right now, the most significant side effect of CBD we’ve seen is its interaction with other drugs. CBD impacts how the human liver breaks down other drugs, which means it can elevate the blood levels of other prescription medications that people are taking — and thus increase the risk of experiencing their side effects. And women who are pregnant or who are expecting to be should be aware of this: We don’t know if CBD is safe for the fetus during pregnancy.

So where does this leave us? Unfortunately, outside of certain rare pediatric seizure disorders, we scientists do not have solid data on whether CBD can truly help the conditions that consumers are flocking to it for — conditions like insomnia, depression and pain. And even if it did, we still need to figure out the right dose and delivery form. Plus, CBD is not without side effects. Here’s the advice that I give to my friends and family: If you’re using CBD (or thinking about using it), please research products and talk to your doctor so they can monitor you for side effects and interactions with any other drugs you take.

So is CBD a panacea or a placebo? The answer is: Neither. CBD is an under-investigated compound that has the potential to benefit many conditions. While it does have side effects, it appears as if it could be a safer alternative to highly addictive drugs such as opioids or benzodiazepines. And thanks to a recent surge in research, we’ll be learning a lot more about its capabilities and limits in the next five years.

Watch his TEDxPershingSq talk now: 

ABOUT THE AUTHOR

Jeffrey Chen, MD , is the founder and Executive Director of the UCLA Cannabis Research Initiative where he leads an interdisciplinary group of 40+ UCLA faculty conducting cannabis related research, education and patient care. You can follow him @drjeffchen or visit his website http://www.drjeffchen.com.

OCT 04, 2019

Some victims of workplace sexual harassment are reluctant to report what happened because they fear the effect on their career. For those who leave their job after experiencing harassment or assault, it can be hard to know how to approach a new job search, application, or interview process.

“It’s a challenging issue. It’s a difficult scenario that more and more people are being placed in. The main thing is to remember you’re not to blame and this situation doesn’t define you,” says Pete Church, a member of RAINN’s National Leadership Council and Chief Human Resources Officer at Avangrid, a leading sustainable energy company that operates in 24 states.

What to do during your search 

“If your goal is to assess how a potential employer understands and addresses harassment in the work environment, then there’s a lot of helpful research you can do before you’re in an interview,” Church suggests. He also recommends going on Glassdoor and reading reviews of the company. Even if you don’t see specific mentions of sexual harassment in the reviews, you can learn about the company culture.

It can also be helpful to find past employees of a company you’re interested in on LinkedIn. You can reach out for a networking phone call to ask about what their experience was like, about the company culture, and if you feel comfortable doing so, why they left the organization. Approach the situation optimistically and know that most companies promote a harassment-free environment.

How to navigate the interview process 

Once you’re in an interview process and asking about the company, you can ask questions that are a little more benign, but still bring you into the core of what you really want to know. These can be things like:

• Tell me a little bit about the company culture?
• Why might someone not feel like a good fit at your company?
• Does your company do an employee survey?
• How does your company show it cares about employees?

If you feel comfortable doing so during the interview process, Church suggests asking questions that avoid being personal but are still focused on sexual harassment, such as: “Unfortunately we see way too many headlines in the newspapers today about workplace violence and workplace harassment. I’m curious about what your company has in place to protect employees?”

What to say about why you left 

The goal is to explain your employment story in a truthful and respectful way that doesn’t raise any red flags for a future employer. Give enough of an explanation so that they aren’t left wondering what happened. But remember, your story is yours. You’re never obligated to tell anyone more than you’re comfortable with. If you signed a non-disclosure agreement with your previous employer, you also need to be careful not to share anything that violates the agreement.

At some point in this process you’re going to be asked why you left. Practice how you want to answer this question ahead of time, either by yourself or with someone you trust, so that you don’t leave any questions or concerns in the mind of the interviewer—but in a way that doesn’t bring back too many difficult memories.

Your answer may be different if you are still employed and are looking for a new job so you can leave versus if you already left your job and are currently unemployed. Either way, it’s important that you rehearse the answer and know exactly what you’re willing and not willing to say during the interview.

“If you’re still employed, it’s best to frame your interest in the job as an opportunity you’re excited about. If you’ve already left your last job, you’ll need to explain the gap on your resume and you should never lie about this,” says Church. Instead, he suggests giving an answer that addresses any questions or concerns the interviewer may have, while not revealing anything personal about what happened. You could say something like, “It was a really difficult decision to leave the company after having been there for x number of years.” However, Church suggests focusing on what excites you about the organization where you are interviewing and how the position aligns with your interests, skills, and career goals.

How much to disclose to a possible employer 

The interviewer wants to hear about how your current skills will add value to their organization. A negative experience with a previous employer doesn’t necessarily provide insight into who you are as an employee and the potential you have to add value to a new company. Negative comments about your previous employer, even when warranted, are risky. They may lead some interviewers to think think you are likely to say negative things about your new employer in the future. The safest approach is to avoid saying negative things about your previous employer.

How to deal with reference checks and retaliation 

Many people who have experienced harassment or assault in the workplace wonder how this will impact future reference checks. “Though most companies are only required to verify dates of employment and title, if you’re worried about retaliation or malicious behavior, it’s best to proactively provide a list of references you’ve chosen who would be appropriate for a potential employer to call,” says Church.

If you feel that everyone at your previous company could be a liability as a reference, then you don’t have to list them. You can give a list of references including past mentors, organizations you’ve volunteered with, etc. If asked why you cannot give your previous employer as a reference, you can say something like: “I left voluntarily because it was not a great culture fit. I loved the work I was doing, but my experience there was not ideal and I’m not confident that they would give the best summary of my job performance.”

A company’s culture is defined not by moments of the worst thing that happened, but by how the company responds once they know about it. Learn more about the work RAINN’s consulting services team does every day to help companies and organizations improve their prevention and response practices.