Examining job-related diseases; effects of marijuana edibles; showing compassion: Upstate's HealthLink on Air for Sunday, May 15, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a new report shows occupational injuries and diseases remain a major public health problem in New York state:

Michael Lax, MD: ... This report was an attempt to quantify how much occupational disease there is in New York state, and also to give some idea of the scope of it: What sorts of things are we talking about when we talk about occupational diseases? ...

Host Amber Smith: And we'll learn about newly legalized marijuana edibles, which come with some safety concerns:

Willie Eggleston, PharmD: ... What that can mean is a fast heart rate, anxiety, being worried about everything going on around you, heightened awareness. And so certainly that can lead to someone having a, what we would consider a bad reaction to the product ...

Host Amber Smith: All that, some expert advice about compassion, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, a toxicologist explains what's important to know about newly legalized marijuana edibles. Then, a psychiatrist shares advice about showing compassion during turbulent times. But first, a new report looks closely at occupational diseases in New York state.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Reducing or eliminating hazards in the workplace could help reduce or eliminate work-related diseases. And yet occupational disease remains a major public health problem in New York state. With me to share a new report on occupational diseases in New York state is Dr. Michael Lax. He's a professor of family medicine at Upstate and the medical director of the Occupational Health Clinical Center. Welcome to "HealthLink on Air," Dr. Lax.

Michael Lax, MD: Thank you.

Host Amber Smith: I think we ought to start with a definition of "occupational disease," if you don't mind. What counts as an occupational disease?

Michael Lax, MD: Sure. I mean, one way to look at it might be a contrast to an occupational injury, to begin with. Occupational injury is what I think a lot of people think of when they think about workplace health and safety. And so an injury is something like a sprained ankle or a broken leg, or when your back goes out because you lift something heavy, and those are the kinds of things that would qualify as injuries.

And the things that characterize them as injuries are, they happen pretty quick. I mean, they happen over almost an immediate time period. So the exposure is quick, and then the effect on the body, the injury itself, is instantaneous. As soon as they fall, they get injured. So to contrast that with the idea of a disease, a disease is more like something that occurs as a result of an exposure that may occur over a prolonged period of time.

And the effect that it has on the body may also take a prolonged period of time to actually show up. An example that would be a classic example in workplace health and safety would be a scarring of the lungs that occurs as a result of exposure to asbestos. That's called asbestosis. So people generally get exposed to asbestos over a period of time. And then later they experience a scarring of the lungs, but usually that scarring doesn't occur for at least 15 years after the initial exposure takes place,so that's kind of an obvious example that contrasts what I mean by a disease as opposed to an injury.

And diseases are, as I think it says somewhere in our report, at the beginning of the report, what's interesting, for us in the field, disheartening actually, about occupational disease is that it's so common, yet it's also so overlooked that it doesn't get paid attention to.

And doing this report was an attempt to quantify how much occupational disease there is in New York state, and also to give some idea of the scope of it: What sorts of things are we talking about when we talk about occupational diseases?

So I gave you the basic definition there of an occupational disease. But I think that it's worth it to spend just another minute talking about adding some complexity.

Host Amber Smith: Let me ask you, when you mentioned diseases: In the past couple years, has COVID been counted as an occupational disease if the person got sick at work?

Michael Lax, MD: Right. Well, that's a good example that sort of gets at exactly what I was trying to talk about, that, in some ways, yes, COVID, because we heard a lot in the news, I think, about essential workers, and we learned about health care workers becoming infected with COVID, for sure.

But also, people may or may not be aware, there are other types of workplaces where COVID became epidemic, like in meatpacking plants, for example, was a big one. But also here locally, I don't know if people remember, but at some point in the pandemic, there was a large greenhouse operation that's over near Oneida, and there's several hundred workers there, and I think, 200 of them or more became infected with COVID.

And actually, then that's a good segue into, what I'm talking about by more complicated idea of occupational disease, because COVID obviously is not only an occupational disease. You can get COVID from picking it up from somewhere in the community, as well. Just to give you an example of a situation I know that shows some of the complexity, I know a massage therapist and, she was working early on in the epidemic, and she was working unmasked. The person she was working on was unmasked, and the patient didn't tell her that they were having symptoms or were sick. The massage therapist becomes ill and finds out that that patient had COVID.

So that's clearly a work-related thing for that massage therapist. She goes home. She lives with her husband and her daughter. So she goes home, she passes it to her husband. He gets sick. So there we have a home exposure. Her husband then goes to work. He goes to work, and he infects his boss. So there's a workplace exposure.

Meanwhile, the daughter gets sick as well. She calls her employer. Her employer says, "Don't come in to work." Fortunately, good advice, but then gives her bad advice and tells her, "But don't go get tested, either," because, he says to her, "We don't want to know because of the consequences for us at the workplace." So, that episode for me really epitomizes some of the complexities of not just COVID, but other occupational diseases where the pathway is not so straightforward, you know, with it's only at work where the exposure occurs. So to get back to your question, yeah, some of COVID is work-related but I'm not sure that everybody at this point really thinks of it anymore that way. This is speculation, but I think there was not a lot of eagerness on the part of many to recognize it as occupational, because, I think, of the implications of that. And so New York state and a lot of other states actually didn't even keep statistics, to allow a good analysis of how much is work-related. So it's been really difficult to tell. And so that's a good example of, when I say complexity of nowadays, when you're talking about occupational disease, that's not necessarily so simple, straightforward "get exposed to asbestos in the workplace, get asbestosis," right?

Now it's like, "OK, I have COVID. Did I get it in the workplace? Did I get it from home? How do I tell the difference?" And a lot of diseases are like that, where there's possible non-working exposures. Sometimes it's multifactorial, like I think you mentioned stress as an example.

Stress is something that people have out of work. So they can have stress at work. Lots of people find their family to be a huge, their biggest, source of stress. So it's not uncommon for people to have stress at work, away from work, and so in the end, they may have a stress-related health problem, but more than work may be contributing.

In a sense, it's not really that problematic in that if you forget about legal issues or medical/legal sorts of issues, from a sort of medical/scientific point of view, it's, I think it's important to figure out that work is playing "a" role, but in any individual case it's not necessarily so important to figure out was it "the" cause or was something else the only cause. Because the bottom line is that if we recognize that work is playing a role, at least we'll pay attention perhaps to work as one of the factors that could be causing the problem. And we'll start paying attention to what can we do in the workplace as well as outside of work to try and reduce the hazard and avoid these sorts of health problems.

I think what makes it difficult is the medical/legal environment is such that the health context that we operate in has, because of historical reasons, has separated occupational disease into this own thing that's separate from general health concerns from an insurance standpoint, so that there's a completely separate system, the workers' compensation system, set up to handle occupational disease problems. And as a result of that, when you get put in that system, the system requires you to prove that your disease was caused by work. And so you get into this either/or dichotomy thinking that, from a public health or from a strictly medical standpoint isn't necessarily all that useful.

Host Amber Smith: Well, let's get into your report a little bit, because I'm curious about the incidence of occupational disease in New York state, and whether it's changed since, you know, 30 years ago, New York had all of these manufacturing jobs, so things are different today. What did you find?

Michael Lax, MD: Well, exactly. And that was one of the major impetuses for us wanting to do this report, because the last time that anybody, I think, as far as we know, tried to take a comprehensive look at this question in New York state was in the mid-1980s.

And like you said, boy, a lot has changed since then in terms of where people are working and the conditions under which they are working. And, having been around since, almost that time -- I came here in the late 1980s -- I've seen the changes every day I drive to work. My office is out just north of Carrier Circle, so just driving by the Carrier plant where there used to be two or 3,000 jobs is just a clear indication of where things have gone in the last 30 years. So, yeah, we've lost a lot of those big manufacturing plants, and the manufacturing that does exist is now in smaller, more dispersed kind of workplaces.

We've had an explosion of service-sector- related jobs. So office jobs, and here in Central New York, like a lot of parts of New York, now the sort of major industries areeducation, health care, food service and hotels, restaurants, kinds of things. Office jobs are really big. So yeah, there's been a big change in where people are working, and that obviously has an impact on what sorts of illnesses people may incur in the workplace. The other thing that's important to recognize is that it's not just the hazards themselves or the jobs themselves that are important in terms of posing a risk for occupational disease, but also the conditions under which people are actually doing that work. So in other words, what I mean by that is that, for example, a lot of the work our report found that had been increasing over the last couple of decades, is work that we call low wage that we group into a category of low-wage work.

And those low-wage jobs tend to be non-union jobs, where workers work at will, so they have no contractual protections from their employer. They tend to be in workplaces that are not necessarily high-profit; they're operating on a low margin.

And workers are pretty much working under conditions that are pretty difficult a lot of times. From a stress standpoint, they have very little control over their jobs. They've got little control over when they work. They have little control over the conditions under which they're working.

And they oftentimes have no outlet to be able to go, or they don't know about resources that might help them in terms of dealing with those issues. But if they do, they may be quite worried about utilizing those resources because, the job is precarious. They fear that if they're labeled as a troublemaker, as a person that's making waves, that they could just be out of a job.

So I think that tends to really tamp down people's willingness to step forward and say, "Hey, I think something is going on here that needs being addressed." So that I think is also an important change that's occurred over the last couple of decades because, really labor unions in New York state are still relatively strong compared to other states, but we've seen a huge hemorrhaging of labor union jobs, even in New York state, over the last two or three decades.

And when it comes to safety and health, in New York, nationally, even internationally, labor unions are one of the strongest voices that stand up for workers and for their health on the job, historically speaking. And so when those unions are weakened or when they're gone from an industry, then workers lose that voice and that protection. And that's another sort of big thing that's happened here in New York affecting work, I think.

Host Amber Smith: Do you have a sense for how many serious injuries or deaths happen per year that are tied back to the workplace?

Michael Lax, MD: We estimated that, and people have to understand these are just estimates, because one thing we found and people can see from the report, is that just a lot of data is not collected, so you have to find different data sources to be able to put it all together into some kind of coherent picture. In terms of occupational disease, we estimated that a little over 7,000 people per year die in New York state from an occupational disease. If you put that in context, I think, cancer and heart disease are one and two in terms of most frequent causes of death. And they're up around, maybe 35,000-40,000 deaths, something like that.

But then number three is accidents, and accidents is about 7,500 deaths. So occupational disease is right up there in terms of causes of death, higher than stroke, higher than Alzheimer's disease, higher than deaths from opioids or overdoses. So that's what I'm talking about, a problem that'svery present, but not paid attention to. I think occupational disease kind of gets lost in terms of its importance when you think about it in that context. In terms of occupational disease, the morbidity, or people not dying from the disease but getting sick from an occupational disease, those numbers we did a little differently because again, limitations in the data that we had.

So at any given time in New York state, we estimate that a little over 13% of the total disease volume in the state, in other words, all the people with all different kinds of diseases, that occupation is playing some role in contributing to that disease. So about 13% of disease at any one time in the state, which is huge.

I mean, it's a big, very big burden, but if you look at deaths versus people getting sick, they kind of are different in terms of what those diseases are. In terms of occupational disease deaths, I forget the exact number, but I think it was about three-quarters or more was due to heart disease and cancer. Those were the two big ones.

For occupational illness, that's where people are not dying from the illness, it's more like over 50%, I think, were musculoskeletal disorders, and another big chunk were respiratory disorders. So there's a contrast there. And when I say musculoskeletal disorders, again, I'm talking about musculoskeletal disorders, not your sprains and strains and falls. No, we're talking about musculoskeletal disorders that occur from a repetitiveoveruse of a person's body that results in things like carpal tunnel syndrome or tendinitis at the elbow or shoulder tendinitis or chronic back problems, those kinds of things.

Host Amber Smith: We'll be back with more information about occupational disease in New York state after this short break. You're listening to Upstate's "HealthLink on Air."

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with Dr. Michael Lax. He's the medical director of the Occupational Health Clinical Center at Upstate. And we've been discussing a new report about occupational disease in New York state.

I know there's emphasis on safety in the workplace, but is occupational disease always preventable?

Michael Lax, MD: Well, theoretically, yeah, because if you can identify hazards in the workplace that are connected with the risk of occupational disease, then those hazards can be reduced or eliminated in the workplace. So theoretically, yes. In practice, obviously, that's not happening.

Host Amber Smith: Your report focused on New York state, obviously, but do you believe other states have similar issues?

Michael Lax, MD: Oh, sure. Yeah. And I think that every state, has the same sort of issues in terms of having occupational disease, that's present, but really not paid much attention to. What may differ from state to state is the actual profile of diseases, because, obviously in certain states the workplace profile is different, so that there may be more mining, there may be more construction, there may be more manufacturing or things in different states where there are different kinds of hazards. But overall, yeah, this is a national problem and one in which I wouldn't want to give the impression that New York state lags behind other states in this area, even though I'm saying, yeah, there's a lot of issues and it's still clearly very prevalent because New York state actually has been a pioneer in trying to address the issue of occupational disease, because 30 years ago or 30-some years ago, which is the reason I came to Upstate and originally was to become the medical director of the Occupational Health Clinical Center, which is a part of a statewide network of occupational health centers that New York state publicly funds and has publicly funded since 1987 specifically to address the issue of diagnosis, treatment and prevention of occupational disease. So New York state, I think, has, not just a clinic network, but other infrastructure to address this problem. The fact that the problem still exists and is, such a huge problem, says something about the immensity of the problem and also the difficulty of addressing it, that you don't just address it by having a few clinics and send relatively few number of doctors and staff trying to address it. It's a problem that needs, really, attention from a whole array of participants.

Host Amber Smith: What are the most common hazards or the top hazardous industries in New York?

Michael Lax, MD: In the original report that was done 30-some years ago on occupational disease, they actually had lists of the most hazardous industries, from data that at the time was being collected by national organizations, OSHA, the Occupational Safety and Health Administration, and NIOSH, which is the National Institute for Occupational Safety and Health, which is the research side of things at the federal level. So we tried to do the same thing. We tried to access data that would allow us to list, like you just asked, what are the most hazardous industries? It seems like a pretty straightforward, simple question and turned out to be impossible to answer because that data that they collected 30-some years ago has never been collected since.

As a result of that, we wrote a whole chapter on trying to estimate risk of occupational disease and try and figure out what are the hazardous industries in the state and how many people might be exposed in them. But we had to do that really piecemeal. For each specific hazard, like asbestos or silica or lead or chemical exposures generally, we had to use different data sources and different technique for trying to estimate it. That's why that section is really, I think, I look at it as kind of like trying to put the pieces of a puzzle together, and we sort of have gotten some of those pieces to fit together, but we don't have the complete picture.

But to get back, to try and answer your question: so what we did was, we thought that, even though, like we talked about before, New York state's economy has changed pretty dramatically, that doesn't mean that all of those traditional hazards that we think about as being associated with manufacturing or mining or dangerous sorts of occupations, those have not disappeared.

So we looked at chemical exposures. We found several hundred thousand, I think, workers exposed to a relatively small list of potential, chemical exposures. We found significant people still working with asbestos, found a lot of people still working with silica. Musculoskeletal hazards are huge in terms of, again, this repetitive overwork kind of thing. Literally probably net numbers in the millions of workers exposed to that. Stress, is huge as an issue. And as the last couple of years have shown, we have to pay attention to infectious disease, because that's sure proved to be a major problem, in the last couple of years with COVID.

Those, I think, give a sense of some of the issues, but some of the issues also are not necessarily traditional, are not necessarily what you would think of as occupational health issues, for example, stress. When people think about stress, it's a vague term, and I think a lot of people use it that way. And 30 years ago, I think, when people said your disease or your problem is caused by stress, it's like the last resort when you go to the doctor, if they can't find an answer, it's oh, it must be stress. But I think that there's been a lot of work since then to really define what we mean by stress and to make stress into something that can be defined. It can be looked at like any other hazard in the workplace, like a dust or like a chemical or whatever. And some of the factors that they've found out that are associated with stress are on the combination of if a person is working at a job where there's a lot of demand on them, not necessarily physical demands, but more like the psychological demands to produce or deadline or to keep up with an assembly line or,if you're working in a warehouse, you're on a timescale to really pick those items fast and get them out to where they need to go.

So, those kinds of demands linked with lack of control over the job so that the less control a person has over the job, in other words, the less control they have over the speed of that conveyor, no control over how the work gets done, and working on heavy deadlines or working with somebody always breathing down their neck to get it done, get it done.

Those sorts of things, linked with the high demands, is one thing that has really, I think, been well-defined as linked to cardiovascular disease, heart attacks, high blood pressure, stroke, as well as a range of other health problems: mental health- as well as physical health-related issues.

But in addition to that, I think that there's things like social supports at work. So does a person feel alone? Are they dealing with the problems that they have on their own? And just to give you an example of that, I had a woman who was working in a factory and she had worked there for many years, a manufacturing plant, and, she was promoted to become a forklift driver, and she was the first woman to ever get the seniority, to achieve that position. And as soon as she got into that position, she started getting harassed by men on the job, because for whatever reason, they couldn't deal with a woman who had achieved this position. So she was getting harassing messages on the little display that dispatched her on her forklift to where she was supposed to go. Comments, all kinds of stuff going on at the workplace. And she was completely alone. She was the only woman doing this. And so for her, that lack of social support, along with the harassment and incivility and bullying that she was experiencing, was a big issue in terms of creating that stress for her.

I think that stress is something that is rampant. It's in many, many different workplaces. We find that when we go out and speak to workers in all kinds of situations that stress is often No. 1 concern. And with good reason. I think the more we learn about stress, we're also learning that it's linked with many different kinds of health issues, some of them really, really, obvious and overt, like a heart attack or a stroke, but some of it more subtle, like things you don't see, like effects on the immune system, for example, or does thatlink to pathways that break down the body's ability to resist things, like even the development of cancer in the long term?

So stress is a big issue, and a lot of people think of it as not a big deal, but how we deal with stress, I think really is a big deal from a health standpoint.

Host Amber Smith: Would a worker who believes they were injured or became ill because of something in their workplace, would they go to their own primary care doctor or would they try to find an occupational medicine specialist, like yourself?

Michael Lax, MD: Well, there's two parts to that answer.One Is from the medical standpoint, they can go to any doctor they want. When I first came in the '80s, a lot of docs in the community handled the routine stuff. They handled routine sprains and strains and all that kind of stuff. And some of them, are interested in or have experience dealing with more complicated occupational disease issues. But the reason our clinic was set up and our clinic network was set up was precisely to deal with the problem (for) many docs in the community. When you look at medical school training, virtually no doctor comes out of medical school with training in occupational -- recognizing occupational -- disease. The amount of time spent in curriculums and medical school is almost nothing. So, a lot of docs need help in terms of figuring out what's going on with a person who may have an occupational disease. So a patient may initially try and go to their primary care person, but then that primary care person may then refer the person to us, to an occupational medicine specialist, or the patient can go directly to an occupational medicine specialist. What's complicated things over the last probably 15 years, is that many doctors in the community, primary care doctors as well as specialists, have stopped accepting workers' compensation insurance. And that's for a lot of patients reached kind of crisis level because they can't find a doctor in the community who will take workers' compensation, even for a simple, run-of-the-mill thing that primary care doc or specialist can handle easily.

So that has created problems because our facilities are limited. Our occupational clinic network is limited. I think there's, eight clinics around the state. And what we've seen is that workers not only with occupational disease, but occupational injuries, now are coming to us or trying to come to us because docs in the community don't take workers' compensation, which I think is a real shame because I would argue that, it's part of your deal as a physician or your reason for being as a physician, is to advocate for your patients. Right? And I think that in order to fully advocate for your patients, you need to advocate for them, with them when they have a work-related disease or injury as well as if they don't. I think a lot of patients are getting shortchanged that way, but on the other hand, I understand also that the workers' compensation system is a very difficult system for patients and also for doctors to deal with and their offices to deal with. A lot of doctors just get fed up with the paperwork, with the hassles, the demands, the denials, and it's hard to practice decent medicine under workers' comp a lot of times. So, a lot of offices decide that it's just not worth it. And they have been dropping out, butthe workers' comp board tells us that they've been listening to these issues, they're not oblivious to them, and that they've really been trying to find ways to keep docs in the system and bring docs back into the system, improving communications, improving the accessibility to the comp board. And so they're actually involved in a kind of active outreach I think you're going to see it over the next, year or more that they're going to try and bring docs more in, but "Will that be successful?" is a good question. Because I train residents; for example, I go talk to residents in family medicine about, workers' compensation and dealing with the comp system and trying to be practical about it.

And, their attitude when I start the session is, most of them are like groaning, "Oh God, I can't stand it. We have had to deal with these forms and the comp system and all that." And by the end, there might be some of them that might be convinced that yeah, maybe we should be doing workers' comp, but there's still some, I've had, it's not uncommon at the end of the session, I ask them, they're all third-years (final year of medical school), where are you going after you finish? They say, yeah, I'm going to go here or there or wherever. But some of them say flat out, "I'm not doing worker's compensation, period. You didn't convince me." So that's a big problem.

Host Amber Smith: Well, Dr. Lax, I appreciate you making time for this interview.

Michael Lax, MD: Thank you for having me. I appreciate the opportunity.

Host Amber Smith: My guest has been Dr. Michael Lax. He's a professor of family medicine at Upstate and the medical director of the Occupational Health Clinical Center.

I'm Amber Smith for Upstate's "HealthLink on Air."

What you need to know about marijuana edibles -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Marijuana edibles are legal in New York state for adults 21 and older, but that doesn't mean they're safe to use. For help understanding what to watch out for, I'm speaking with Dr. Willie Eggleston. He's a clinical assistant professor of emergency medicine specializing in toxicology, and he's part of the Upstate New York Poison Center.

Welcome back to "HealthLink on Air," Dr. Eggleston.

Willie Eggleston, PharmD: Thanks, Amber. I'm happy to be here.

Host Amber Smith: To begin, I'd like to ask you to explain what cannabis does to the body. How does it work?

Willie Eggleston, PharmD: Well, that's a big question. In general, when we think about cannabis or marijuana, it's important to remember we're talking about the plant or things derived from the plant. And so there's a lot of different chemicals and compounds in there that can have a lot of different effects on the body. In general, marijuana can cause some sleepiness, some sense of euphoria, and generally that's the reason that people are seeking out its use.

Host Amber Smith: So the big ones that we hear about, the big initials we hear about are CBD and T H C. Are both of these things in marijuana?

Willie Eggleston, PharmD: They are. And depending on how you grow the plant, that can be there in different concentrations, and they have very different effects on the body. So THC is the one that people are typically experiencing the sensations that they're familiar with when they use marijuana. It's the psychoactive component of marijuana. It's the part that causes the euphoria. It's the part that causes the high that people are seeking out when they're using marijuana. CBD is a little bit different. It actually blocks the effects of THC at the main receptor, and it can cause a whole host of different effects that are still being researched for medicinal reasons today in the United States.

Host Amber Smith: So it is my understanding, you can find products that have both CBD and THC, and you can find products that are CBD only. Can you also find products that are THC only?

Willie Eggleston, PharmD: So, any product that you're using that is marijuana or derived from marijuana is going to have both in there. Now, people can manipulate the plant in ways that increase one or decrease the other. And so it's important to look at the dosing on the product you're using, if it's available. You can find CBD only products currently available in New York and across the United States. These are derived from hemp. Hemp is a special strain of marijuana that contains no THC, and so you're able to get CBD from that plant. It's harder to get products that are just THC with no CBD, but certainly there are recreational products available that have very, very high concentrations of THC and very, very low concentrations of CBD. So you can find things all across the spectrum.

Host Amber Smith: So it sounds like the products are going to differ quite a bit. What symptoms may indicate that someone is having a bad reaction to the product they've used?

Willie Eggleston, PharmD: So some of the more common adverse effects that are reported to us include things like what's called a dysphoric reaction. You might think of that as like a bad trip. So that can depend on that individual, that individual's experience with marijuana, the setting that they're using the product in. But in general, what that can mean is a fast heart rate, anxiety, being worried about everything going on around you, heightened awareness. And so certainly that can lead to someone having a, what we would consider a bad reaction to the product. Outside of that, certainly because it does cause the individual to become more sleepy, and it delays their reaction time, there can be difficulty with completing tasks that are normally easy to do. So we encourage people not to use this if they're going to have to do any tasks that involve a thought process or quick reaction time. It's just not a good combination.

And then lastly, there's some ongoing research to suss out how risky is this for individuals with other chronic diseases, for example, psychiatric diagnoses or heart conditions that may lead it to be more dangerous with longer-term use.

Host Amber Smith: I wonder, is there a difference in the way it's ingested -- smoking or vaping versus if you swallow it in an edible. Are the effects going to be different?

Willie Eggleston, PharmD: They are very, very different. And that's one of the important messages we want people to be aware of as recreational products become available in New York. We know that adult use of marijuana is coming. We know that dispensaries will be open soon. And so it's important for folks to understand if you've smoked a product in the past, and now you're using an edible, although the chemicals in there are the same, the way that they take root in your body is very, very different. When you smoke generally, you know the effects from that dose within three to five minutes. It's very, very rapid acting. And it goes away fairly quickly too. The effects are gone within a couple of hours. Whereas edibles, it takes about two to three hours to even start to feel the effects, and up to six hours to know how strong those effects are going to be. And once they start, they last for many, many hours. So in general, when you think about smoking versus edibles, smoking works fast, lasts for a short amount of time. Edibles take a long time to start, and once they start, they last for a very long time. So if it's your first time using an edible product, you want to start with a very low dose. You. Want to take that dose, and you don't want to take any more. Even if it's been an hour and nothing's happening, it doesn't mean nothing's going to happen two hours from now. So you really want to, start low, see how that affects you, and then gradually you can increase with subsequent uses.

Host Amber Smith: You mentioned that research is ongoing into chronic conditions that people may have and how that may or may not be influenced. Is there any way a person can, sort of, predict what their reaction is likely to be?

Willie Eggleston, PharmD: There's really not. You know, we certainly know in individuals who use marijuana more frequently, they kinda know how their body reacts to the product. But in someone who just uses occasionally, we really don't have any good information to figure out who's going to have a bad reaction. In general, how much does it take, or how frequently does someone need to use it to develop something like a use disorder? Those are things that we're still trying to answer.

What we do know is that chronic use or regular use of marijuana can lead to something called cannabinoid hyperemesis syndrome. And that's a fancy medical way of saying the patient starts to vomit and they vomit a lot. They feel nauseous, they feel cruddy. And the typical medicines that we use to treat the nausea and vomiting don't work very well for cannabinoid hyperemesis syndrome. So it's certainly a problem, and it's one that public health officials and medical folks are trying to get a better response to, get a better handle on. But it's still an emerging issue that we're learning about.

Host Amber Smith: Why do people report getting the munchies when they, at least when they smoke marijuana? And I wonder, does that happen with edibles as well?

Willie Eggleston, PharmD: That's a great question. Yeah. Marijuana in the body is really a very fascinating thing, and it's something we don't know a whole lot about still, despite it being around for thousands and thousands of years. The receptors that marijuana binds to in the brain, we have more of those receptors than any other receptor in the brain. And they affect so many different organ systems, including our hunger. A couple of different changes happened when marijuana enters the body, one of which is it upregulates a hormone that tells us, "Hey, it's time to eat. I'm hungry." It's one of the reasons we can use a marijuana-like product to treat diseases in which patients have very low weights and we need to increase their appetite. So it does do that. It does a whole host of other things. And it does that if you smoke it, if you vape it, or if you ingest it.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with Dr. Willie Egleston from the Upstate New York Poison Center. Dr. Eggleston is a clinical assistant professor of emergency medicine, and he specializes in toxicology.

Is marijuana addictive?

Willie Eggleston, PharmD: That's a little bit of a loaded question, but the short answer is yes. We have a spectrum of how addictive something can be. And we have things like opioids that we think of as a classic example of things that can cause a substance use disorder. And marijuana is on that spectrum. We just don't know where it is on that spectrum. It seems to be at the lower risk end, but in individuals who do use the product regularly, frequently, we know it can interfere with their job, with their life, with their family and relationships, with legal problems. And it does have a withdrawal when you take the drug away. And so it does cause a use disorder. We just don't know how frequently and how severe that use disorder is. And we're still learning about how to best treat that.

Host Amber Smith: You mentioned how it stays in the body longer if you consume it as an edible and that it could stay with you and feeling the effects of it for hours. So if someone's a recreational user on the weekend, how can they be sure that they'll be fresh to go to work Monday morning or school Monday morning?

Willie Eggleston, PharmD: It does stay for hours, but generally, the next day, it's out of your system from the psychoactive component. What I mean by that is that the compound that's in marijuana that causes the altered mental status, the delayed reaction time, the euphoria, that, even with edibles, that is generally at a low enough concentration the next day that it's not going to have any impact on you. When I talk about duration, meaning like instead of two or three hours with smoking, we're talking more like eight to 12 hours of duration with edibles.

Host Amber Smith: Are there any medications or supplements that are dangerous to use while using marijuana?

Willie Eggleston, PharmD: Sure. In general, we recommend not mixing marijuana with anything if possible. The effects of marijuana can be changed dramatically if they're taken with, particularly products that are sedating, so alcohol, benzodiazepines, medications used for sleep. They can really increase the effects of it on your reaction time and your sleepiness. And then when taken with stimulants, it can really increase potentially that risk for reactions that are not pleasant, dysphoric reactions. And so in general, mixing marijuana with other products is not a great idea. And as I said earlier, one of the populations where we're still learning about a risk of combining marijuana with other disease states: certainly older adults with cardiac conditions. We know that to be a potential risk for bad outcomes when mixed with marijuana.

Host Amber Smith: I'm assuming it's unsafe to drive under the influence of marijuana because you have slowed reaction and impaired judgment...

Willie Eggleston, PharmD: You are assuming correctly. Yes, it is absolutely dangerous to drive under the influence of marijuana. And we certainly recommend strongly against it.

Host Amber Smith: What about CBD-only products?

Willie Eggleston, PharmD: That's. A tough question to answer. CBD-only products can cause you to be a little sleepy or drowsy when you use them. And so we do encourage the first time that someone's using a CBD product, they want to avoid things like driving or other activities that require coordination. But once someone is using a product and they know how they react to it, from there, they can kind of make decisions as to what's safe for them to do. In general, there's not a whole lot of research on CBD and its effects on driving or other activities that require reaction time. But marijuana, for sure, we have substantial research to demonstrate that it significantly delays reaction time, and it's not a good combination with someone driving a car.

Host Amber Smith: What about marijuana use during pregnancy, or during breastfeeding?

Willie Eggleston, PharmD: So marijuana use during pregnancy has been fairly extensively researched. It's not like alcohol or other substances that impair the development of the unborn child. But the child, when they are born, sometimes they have a lower birth weight, so their weight is lower than that of a typical baby born to a mother not smoking marijuana. And sometimes that can lead to admissions, to a neonatal intensive care unit, an ICU for babies. And we know that the incidence of babies going to the ICU is higher in mothers who smoke marijuana than those who don't. Aside from that, there's not a whole lot of other data to show that it's risky, versus not risky. There's no real compelling evidence to show that it has long-term effects on development once the baby's born. And as far as babies who are breastfed by mothers who smoke marijuana versus mothers who do not, again, we know that marijuana gets into the breast milk. We know that it gets into the baby's bloodstream, to some degree. But we really don't have any evidence to show that that has a detrimental effect on the baby.

Host Amber Smith: Interesting. Well, I'd like to ask you about storage of edibles. Do marijuana products have a shelf life, or does their potency fade over time?

Willie Eggleston, PharmD: In general, most edibles will have a similar shelf life to the product that they are made in as long as they're prepared correctly. So for example, an edible gummy will have a shelf life that is much longer than an edible cookie or an edible drink or an edible condiment. But when thinking about these products, as far as how to store them, I encourage people that even though a lot of the edibles are in food products, not to think about these as food products, to think about these as medications. When we worry about risk and exposure the concerns that we have are magnified tenfold, a hundred fold when you think about kids getting into these products. An adult getting a little bit sleepy, no big deal. A kid getting the same dose of marijuana gets far more sleepy, can have difficulty with their breathing, may require admission to an intensive care unit. And so we encourage folks who have these in their home to store them up away out of sight, ideally in a locked container to avoid those unintentional exposures in little kids.

Host Amber Smith: I wanted to ask you, if a child or even a pet at home ingests an edible, you know, accidentally, and someone calls the poison center for help, what are you likely to ask the person? What are you looking for?

Willie Eggleston, PharmD: So we'd be looking for signs and symptoms of the ingestion, which initially would include things like sleepiness. And most of the time, kids who get into these products, because they are so unpredictable, because they're not designed to be used in two- and three- and four-year-olds, they generally will require observation in an emergency department for their symptoms because they can get severe.

Host Amber Smith: What is the treatment for an overdose? A person could take way too much, eating too many edibles. I can see where that would happen. If the effects don't happen and they think, oh, I need more. Someone could really ingest quite a bit of this before they get into trouble. What is a treatment for an overdose?

Willie Eggleston, PharmD: We don't have an antidote. There's not something we can give someone to reverse the effects of marijuana in the body. It's mostly just using the medications we have to treat the symptoms that are present until the marijuana has left the body. So for example, if someone is very anxious and nervous and they're having a bad trip, we can give them medications to calm and relax them. But it's mostly just supporting the patient until the marijuana is out of their system, they're back to their normal baseline and they can safely go home.

Host Amber Smith: Well, this has been very informative. I really appreciate you taking time to explain this to us.

Willie Eggleston, PharmD: Oh, sure. Absolutely.

Host Amber Smith: My guest has been Dr. Willie Eggleston from the Upstate New York Poison Center. He's a clinical assistant professor of emergency medicine, specialized in toxicology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from child and adolescent psychiatrist Dr. Nayla Khoury from Upstate Medical University. How can we show compassion during turbulent times?

Nayla Khoury, MD: These are hard times for everyone. The state of the world is a pretty scary place for many people, and so, in addition to expecting that anxiety, stress, anger and grief might be some emotions people are experiencing, it can be helpful to also cultivate compassion as one sustainable practice to help us cope. So compassion is the ability for ourselves to feel with someone else, feels someone's feelings, and also to hold a wish to relieve suffering in some way. And it's that wish to relieve suffering that gives it a sustainable quality and helps us move from just feeling overwhelmed and overburdened to feeling empowered.

So compassion based practices can be absolutely helpful in any time. Some of my favorite mentors, Dr. Chris Germer and Dr. Kristin Neff, have developed compassion-based trainings to help people cope during ... well, all the time, so I wanted to offer one practice, a self-compassion practice, to try with me.

So, I invite you to find a comfortable position wherever you are. And noticing how your body is supporting you in this moment and being awake, alert and at ease, if it's comfortable, you can bring one or both hands, on the space, around your chest or heart or bring your hand to anywhere that feels comfortable on your body.

Closing your eyes, if that feels OK, or finding a soft gaze and just noticing what you're feeling in your body right now. So allowing whatever arises to be just as it is without pushing it away or making it different. There may be numbness or nothing at all that comes up. There may be worry, stress, discomfort in the body.

So what I'll walk you through is a self-compassion break, and the first part of it is just to notice and lean into discomfort in the body. And you can name it for yourself. Say something like this is anxiety, or this is stress, or simply, this is suffering. Naming it, this is suffering.

The second part is to connect with the universal experience of all of us, like this is the human condition. So to say something to yourself, like we're all suffering, I'm not alone.

And the third part is then to ask yourself and listen for the answer on different levels. How can I be kind to myself in this moment of suffering?

Or what is it I need to hear? What is it my body needs? So giving yourself a moment, just to try out those three things in your experience and then release.

So that's a self-compassion break you could do any time, any moment. And we have found that compassion and self-compassion practices can be huge, helpful buffers to stress and depression in high-stress times.

Thanks.

Host Amber Smith: You've been listening to child and adolescent psychiatrist Dr. Nayla Khoury from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Dr. Peter Cronkright is an associate professor of internal and family medicine here at Upstate Medical University. He gave us a poem that reminds us we have come through medically and socially challenging times before. His poem "Making Rounds" gives physicians, in particular, a reason to hope.

"Making Rounds"

Virus taking hold

Calling the shots

Truth be told

Don't sleep a lot

Scary

Distance and hygiene

Not enough

Where to lean

Times are tough

Memory

Having learned

At rapid pace

Classroom turned

Face-to-face

Flurry

Am I ready

For the call

Remain steady

Exposed to all

Reality

Long white coat

Serves as shield

Carrying notes

Virus revealed

Deadly

Gather round

Foot of the bed

Stand your ground

While it spreads

Worry

Point fingers

So much unknown

Panic lingers

Our limits shown

Sorry

Intern year

'83

Lots to fear

HIV

History

James McCague is a physician and writer from Pittsburgh. His poem "Contagion" is similarly eerie in that we do not know what disease we are facing.

"Contagion"

"The mask becomes you," so he said, and could not see her smile.

"It's probably your eyes," he said, "lips often are disguise."

It was a yellow hospital mask with a center stain of red,

Betraying lipstick she earlier had nonetheless put on.

By now she felt a warming blush extending up her face,

And she wondered if it would peek over the mask's edge

Like an early dawn over a horizon.

And so she stood there, like Juliet on the balcony,

Six feet or so away.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air": an update on sexually transmitted diseases.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.Org. Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.