[Van Wilson - PTTC NCO] 11:30:47 They were talking about canon video, CBD, potential harms, side effects, unknowns. [Van Wilson - PTTC NCO] 11:30:50 We'll get started here in just a couple of minutes as we let scroll in. [Van Wilson - PTTC NCO] 11:30:59 And on camera with me or our presenters and a number of our cannabis prevention and work group chairs. [Van Wilson - PTTC NCO] 11:31:06 I'll do full introductions here in just a moment, but I wanted to welcome everybody. Thank you for joining us. [Van Wilson - PTTC NCO] 11:31:12 Today we're almost 700. Attendees. That's exciting. No, I'm excited. [Van Wilson - PTTC NCO] 11:31:19 I mentioned before we had a record number of registrants for this. Almost 2,600. People were as interested as you are. [Van Wilson - PTTC NCO] 11:31:27 And decided to come spend an hour with us and learn about. CBD and a new advisory. From the Fosse Lab and Devon Space Resource Center and Samsa. [Van Wilson - PTTC NCO] 11:31:38 And the PTC, the prevention technology transfer center network where I work and I'll share a little bit more about that in just a moment. [Van Wilson - PTTC NCO] 11:31:53 We do have our chat and our QA. Pods open today and I'll have a little bit of housekeeping here in just a minute. [Van Wilson - PTTC NCO] 11:32:03 Pass the half hour, sorry, if I set the top of the hour. Pass the half hour. [Van Wilson - PTTC NCO] 11:32:08 We will have the PowerPoint available today. Looking at some of the QA coming in here. Also like to invite you to in the chat, just put your name and where you're coming from. [Van Wilson - PTTC NCO] 11:32:23 We had, we have almost 800 people joining us. At this moment and we'll get people just another minute to join us. [Van Wilson - PTTC NCO] 11:32:30 But in the chat there, if you just wanna put in your name and where you're from, oh, chat's been disabled here. [Van Wilson - PTTC NCO] 11:32:42 I'll try again. [Van Wilson - PTTC NCO] 11:32:45 Name and where you're coming from in the chat. [Van Wilson - PTTC NCO] 11:32:51 It's gonna come quick with almost 820 people. You might have to stop and scroll. [Van Wilson - PTTC NCO] 11:33:02 I won't keep this open for longer. That way. Sound onifications are just going wilder. [Van Wilson - PTTC NCO] 11:33:18 People from all over it's literally coming in too fast. From Florida I'm seeing Iowa and North Dakota, Maryland. [Van Wilson - PTTC NCO] 11:33:26 All over the United States. [Van Wilson - PTTC NCO] 11:33:34 Alright, the sec goes on there. We're gonna get started with our webinar now. We've got 846 people joining us here today. [Van Wilson - PTTC NCO] 11:33:46 Gonna change our chat because, having had to deal with this volume for, which is a really good problem to have. [Van Wilson - PTTC NCO] 11:33:53 I'm gonna change it to our host and panelists here. [Van Wilson - PTTC NCO] 11:33:57 I'll slow that down. And we'll go ahead and get started. Welcome everybody. Say my name is Van Wilson. [Van Wilson - PTTC NCO] 11:34:06 I'm with the Prevention Technology Transfer Center Network. And today you're here for a webinar with the National Mental Health and Substance Use Policy Lab on CBD. [Van Wilson - PTTC NCO] 11:34:14 We're gonna be looking at a new advisory that covers the potential harm side effects and unknowns. [Van Wilson - PTTC NCO] 11:34:21 As I mentioned, a little bit of housekeeping. We make every attempt to have these be secure if anything happens and we need to in the presentation unexpectedly, we will certainly follow up. [Van Wilson - PTTC NCO] 11:34:32 If you have a question, the best way to do it outside of this webinar is with the email address here to DBPRC. [Van Wilson - PTTC NCO] 11:34:41 At samsung.hhhhhs.gov and I'll put that here in the chat in just a second. [Van Wilson - PTTC NCO] 11:34:47 We will have a survey at the end of today's webinar and we would graciously ask your time to complete that as well. [Van Wilson - PTTC NCO] 11:34:55 Is the familiar GIP reform. Following our session, you'll also get an email about how to access the certificate. [Van Wilson - PTTC NCO] 11:35:02 We have a 1 h certificate of completion that is available if you are here for hour with us. [Van Wilson - PTTC NCO] 11:35:10 Our events believe is closed captioned. You can access that at the bottom of the screen there. [Van Wilson - PTTC NCO] 11:35:17 Let me double check that I have that. Turned on. [Van Wilson - PTTC NCO] 11:35:28 And we'll get to that. And then finally just to shout out to follow us on social media. [Van Wilson - PTTC NCO] 11:35:33 We are at PTC Network on Twitter or X. This is as it is now in, Facebook. [Van Wilson - PTTC NCO] 11:35:39 And now, LinkedIn. We are recording today as of. Now. [Van Wilson - PTTC NCO] 11:35:47 And today's recording will be available within one week. On the PTC website and everybody who registered for the webinar will be given access instructions for those. [Van Wilson - PTTC NCO] 11:36:01 If you have not heard of the prevention technology transfer center network, it's my pleasure to introduce you to us. [Van Wilson - PTTC NCO] 11:36:07 We are a SAMSA funded training and technical assistance. Granty that, exists to serve the substance use prevention workforce. [Van Wilson - PTTC NCO] 11:36:16 We have regional centers and each one of the 10 HHS regions and a number of my colleagues in our cannabis prevention working group are joining me. [Van Wilson - PTTC NCO] 11:36:29 Hey, both Brittany Wheel, our chair and Scott Danyer, our co chair. [Van Wilson - PTTC NCO] 11:36:34 As I mentioned, we exist to improve the implementation and delivery of effective substance use prevention interventions. And we do this by really trying to meet the needs of the profession. [Van Wilson - PTTC NCO] 11:36:47 And of the workforce. We base our work in prevention science and we use the latest evidence and promising practices. [Van Wilson - PTTC NCO] 11:36:54 At every juncture we leverage the expertise and resources available through this broad alliance that we have formed within and across. [Van Wilson - PTTC NCO] 11:37:04 The health services regions and the PTC. [Van Wilson - PTTC NCO] 11:37:13 You mentioned most of this here, but we disseminate tools and strategies. We provide intensive technical assistance to a small degree and we really want to bring up that next generation of prevention professionals. [Van Wilson - PTTC NCO] 11:37:26 And build the workforce. [Van Wilson - PTTC NCO] 11:37:30 When we formed the network in 2,018 we identified 6 subject matter areas of expertise. And we built work groups around those. [Van Wilson - PTTC NCO] 11:37:41 So. Group that supported the and the back end of our webinar today with Brittany and Scott and myself. [Van Wilson - PTTC NCO] 11:37:50 We're part of the cannabis prevention working group. And I'm going to hand it off now to Britney, our chair, to say a bit more about that. [Britany Wiele - PSW PTTC] 11:38:00 Thank you. Hello, everyone. My name is Brittany Wheelie. I'm the training and technical assistant specialist with the Pacific Southwest BCC and Chair of the Cannabis Prevention Working Group. [Britany Wiele - PSW PTTC] 11:38:09 So this group existed to develop training and technical assistance tools, products and service. Related specifically to cannabis prevention education. [Britany Wiele - PSW PTTC] 11:38:17 And this can be deployed across the entire PGC network. We partnered with the Evidence Space Resource Center on this event to promote the latest SAMHSA advisory, CBD, potential harms, side effects, and unknowns. [Britany Wiele - PSW PTTC] 11:38:33 Good, thank you. We recognize that language matters and words have power. The PTTC network strives to use a firming language to promote the application of evidence-based and culturally informed practices. [Britany Wiele - PSW PTTC] 11:38:49 And at this time I would like to introduce today's speakers. Berto Covelio, Amy Burninger and Krishna and rather Krishnan to begin today's session. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:05 Thank you and welcome everybody. My name is Mubarak and I'm a public health advisor at Substance Abuse and Mental Health Service Administration. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:14 I am pleased to kick off this webinar about an important new advisory from our evidence-based practice resource center or kind of media or CBD, potential harms, side effects, and unknowns. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:27 During the next hour we will learn all about CBD and the risks associated with using commercial grade over the campus CVD. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:35 Next slide, please. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:41 So next slide. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:44 So we will start with a crash course in chemistry 100, and one in biology 100, and one. [Carvalho, Humberto (SAMHSA/OIEA)] 11:39:50 We will then go into what triggered the explosion in CBD sales and usage. Then we will see how available CBD is in US followed by who uses it a little bit of prevalence rates and demographics. [Carvalho, Humberto (SAMHSA/OIEA)] 11:40:04 We will examine why we should be concerned about CBD usage, especially among children and women of childbearing age. [Carvalho, Humberto (SAMHSA/OIEA)] 11:40:13 So with that I'd like to invite Dr. Krishna Hatha Krishna to start with the presentation. [Van Wilson - PTTC NCO] 11:40:19 And before you could go in there, try sharing those slides one more time and just select the window with the slides in it and not your whole desktop. [Van Wilson - PTTC NCO] 11:40:58 Try that one more time, Krishna and share your screen and just select the slides. We will get on a roll. [Van Wilson - PTTC NCO] 11:41:04 We are at almost a thousand people here, maybe by the time. Kristine pulls the slides up. [Van Wilson - PTTC NCO] 11:41:11 999. Come on. We're just right there. Thank you for your patience. [Van Wilson - PTTC NCO] 11:41:40 And Christian, I'm not sure if the switch got turned off on your microphone as well. We are unable to hear you. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:41:54 It's not switched off. Okay, wonderful. Sorry about that. [Van Wilson - PTTC NCO] 11:41:55 There we go, now we can. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:02 Hopefully that's the worst part of the presentation today. Having said that, I'll proceed with the talk. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:10 I want to start by introducing you to the cannabis plant. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:17 Cannabis is a genus of flowering plants. In the Hamp family. Canada, CI. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:24 Which includes hops. This plant. Produces a number of chemicals including the so-called cannabinoids. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:35 These chemicals. Produced in the. Shiny white dots. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:43 Which coat the leaves, the stems and branches. And this whole thing is harvested. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:42:53 Trying and cured and sold as hemp buds. People also buy. Hemp leaves, dried hemp leaves. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:02 Which they either smoke or make into tea. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:06 Among that many cannabinoids that are produced by this plant. 2 of the most abundant are the so-called Delta 9, Tetrahydro, Kanabanol. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:18 Or THC for short. And Canada DIAL, CBD for short. What does the Delta 9 actually mean? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:28 The Delta 9 is an old fashioned term. That means a double bond. Which can be thought of one type of glue that holds 2 neighboring atoms together in the molecule. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:44 What about the 9? The 9 simply means this glue holds. At number 9 to atom number 10. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:43:53 Organic chemistry uses a systematic nomenclature where carbon and certain other elements are given a number. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:01 Using established rules. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:05 This is CBD. Believe it or not, the structure of this molecule is worked out in 1963. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:13 But it wasn't of much interest because it didn't have any intoxicating effects. And Delta 9 THC its structure was worked out in 1964. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:24 By the same team. And its effects were elucidated by simply giving the stuff to volunteers and see. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:31 What happens. So by 1,964 we knew what TAC looked like. We knew what it did to the human body. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:38 But not how it accomplished this. Effect hard effects. It was not until the mid to late 1980 s that somebody discovered A membrane bound specialized protein called receptor. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:44:53 All human cells have a membrane around sort of like a wall to protect its integrity. And it's the this. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:03 Membrane is made up of lipids, phospholipids, proteins, cholesterol. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:09 And it's function also is to allow stuff to go into the cell and leave the cell. And one of the proteins on this. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:16 Several actually proteins on this act as. Something called receptors. Which this particular receptor binds which then produces the THC induced effect. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:32 So you can think of THC as a signal or stimulus. It's actually known as a signaling molecule. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:37 The binding to its receptor causes a change in the receptor protein, which then initiates a cascade of chemical reactions called the signaling cascade. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:45:51 Which produces the psychological physiological effect, EG getting high. It's very useful to think of the receptor as cells and Tanna because it picks up the signal. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:04 And helps with its transduction into a physiological effect. Or you can think of the receptor as a lock that prevents accidental triggering of this system. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:14 And it needs its own key. Here, to turn it on. Because of the specificity of this receptor to cannibaloids, it's called the cannabinoid receptor. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:28 And because it was the first such receptor found it was called the cannabinoid one receptor or CB one R. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:34 A few years later, a second such receptor was found. As usual, biologists called it CB 2 R. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:42 The question that naturally arose is why does the body make these receptors? Body doesn't waste all this takes energy and the body usually doesn't waste energy making things. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:46:53 And around the same time. It was discovered the human body itself makes 2 molecules. Which bind these receptors. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:47:04 Therefore, by definition, they are cannabinoids. Cannabonoids go with cannabinoid receptors. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:47:13 Okay. And this. Cannabinoids are called endocannabinoids being made by the body and the entire system is called the endocannabinoid system or simply ECS. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:47:26 Several physiological functions have been attributed to ECS, which is still being studied. For example, although the precise mechanism is still not clear, It is agreed. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:47:40 That the ECS is important in human reproduction. That's why it's very important to understand the system because exogenous cannabinoids to CBD or THC. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:47:51 May interfere with it. Potentially having adverse effects on fetal and child development and human health. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:00 Other cannibaloids are being developed. Such as Delta A, THC and Delta 10 T HC, both chemical cousins to delta mine. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:10 And usually synthesized from hemp. Unfortunately for us, can a No, it's entering the market all the time. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:21 Now notice how similar these 3 molecules are to one another. Despite the similarity, these molecules have different effects on the body. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:31 For example, CBD, that will not cause intoxication, IE. Give a high, whereas delta 9 is a powerful intoxicant. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:39 Delta 10 is less so and delta 10 and delta 8 is less so. And Delta 10 even less so why these differences remember signaling The strength of the signal generated upon binding these receptors varies with the cannabinoid. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:48:56 With some being stronger signals than others. Think of your car radio, how it receives certain stations much better than others. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:07 And we all say, oh, the signal is much stronger. So that's the whole. Back down to signaling. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:14 Now I've mentioned. Hemp a few times what exactly is hemp [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:20 Hemp and marijuana are both the same plant. With the definitions defined by 2 loss, the agricultural marketing act to 1,946 and the agricultural improvement act of. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:31 2,018. They defined hemp simply as a cannabis plant. With the Delta. 90 A/C concentration that's no more than point 3% on a dry weight basis. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:43 Yeah. Add it to the 1946 act by also defining marijuana as a cannabis plant that simply has more. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:49:53 Delta 98 C, then point 3%. So now that we have seen how hemp is different from marijuana. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:00 Let's examine how CBD. Is different from Delta 98 C. The 2 most abundant cannabinoids made by the cannabis plant. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:10 As we saw, I mean TBD is typically made from the hemp plant and as we've seen it does not cause a high, but it's delta 98 C. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:19 Which is typically made from the marijuana plant. Does produce. Psychoactive effect. I, it's intoxicating. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:27 We also saw how THC works by binding to the 2 receptors, CB one R and CB 2 are. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:34 Turns out that CB one R is more pronounced in the brain and spinal cord the so-called central nervous system. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:43 Thus producing the effects of intoxication, hunger, etc. CB 2 R, it turns out, is more prominent than the rest of the body. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:50:52 Especially in immune cells. Hence, it's association with inflammation. CBD on the other hand is low affinity for these receptors. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:03 But it does bind. Other receptors and with ion channels. It's mechanism of action is still being worked out, but it's known to inhibit the breakdown of the natural endocannabinoids that I mentioned and possibly THC. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:19 Now the body just doesn't make these things and leave them there. They last for otherwise it's just too too much. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:25 You don't wanna be over. Stressing or over stimulating the system. So the body makes it, uses it, gets rid of it. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:32 And if you can't get rid of it, then obviously it's gonna hang around. So using CBD with THC. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:39 May exacerbate. The effects of THC on the body simply because it's hanging around. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:45 For much longer periods of time. So now we everybody knows that CBD is available everywhere. So what prompted this? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:51:53 Flood of CBD products. Why is CBD everywhere? Well, as we mentioned on December, 20, well, I didn't mention the date, but 2018, the agricultural improvement act was signed into law. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:06 No, the 2018 farm bill. What this did, what this act do was amend the agricultural marketing act of 1946 and made hemp legal now. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:21 It used to be illegal. It legalized the commercial production of hemp. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:27 By legalizing hemp. The law effectively permitted the legal sale of hemp derived cannabinoid products. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:38 This loosening of restrictions on CBD opened the floodgates to CBD marketing and sales. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:45 That have grown and keep growing. CBD products are increasingly marketed as a cure all for a range of medical conditions in ailments. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:52:55 Despite limited evidence for their effectiveness. However, there is one FTA approves CBD treatment in the marketplace, which is epidelics. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:07 Happy Dealex is a pharmaceutical great CBD. Which is prescribed for epilepsy that does not respond to conventional medications. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:18 It's usage is allowed for humans one year and older. Of course you need a prescription from a healthcare provider before you can get it. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:28 Can only buy it on a and it's administered orderly with the oral syringe just sold. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:33 I mean, shown here. But. What about CBD that's sold in stores? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:42 Well, these over the counter products, commercial great CPD products. Are not. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:53:51 Are not. Fda approved. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:00 So what are these over the counter products that are sold? And how does the FTA feel about them? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:09 Oh, what the count to see with the products that are often marketed. As therapies, to feed various mental and physical conditions. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:17 Now, including for pet health. These claims have not been rigorously. Proven, but limited data available. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:27 The FDA is raised safety concerns, especially with long-term use. It does not approve marketing of CDP products as food or dietary supplements. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:39 In fact, the SIP recently the FDA concluded that after much review. Existing regulatory frameworks for foods and supplements are not appropriate for CBD. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:50 And a new regulatory pathway is needed for CBD. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:54:56 Now that we know that CBT is marketed heavily. Where is it sold? It's available, various by state, it's available throughout the United States now. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:06 Online retailers, brick and motor retailers, you can buy it at CVS, you can probably buy it. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:13 Well, greens, grocery stores carry it, convenience stores carry it, my local. Supermarket carries it. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:22 Can even buy it in gas stations. However, most CBD sales approximately 66%. Of CVD sales today are made online, but this proportion. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:33 Is expected to decrease. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:36 But, you know, just when you think you've seen it all, you can now buy CBD products from vending machines in several states and of course several countries in the world. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:47 So now let me know what is available. Where the question that arises naturally is who is using this stuff anywhere? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:55:56 To educate us on the subject and others, I'll turn to talk over to Amina. Amy? [Amy Berninger - EBRC] 11:56:03 Thanks Krishna. Well, most American adults are familiar with CBD, user demographics tend to skew. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 11:56:10 Oops. [Amy Berninger - EBRC] 11:56:12 Oh, age groups, Americans aged 18 to 29 are the most likely to use CBD consistently and the numbers nearly double for those who have tried it at least once. [Amy Berninger - EBRC] 11:56:22 Nearly half of those adults who use CBD products believe that they are regulated by the government, which likely contributes to the large number of individuals who feel comfortable using them. [Amy Berninger - EBRC] 11:56:31 As the number of American adults who are familiar with and feel comfortable using CVD products grows, so will the already significant market share that is resulted. [Amy Berninger - EBRC] 11:56:40 The large proportion of American adults who use CBD has created a significant market for related products. According to the Breakfield Group, in 2,019, California, Florida, and New York were the top states for CBD sales accounting for more than a quarter of the 4 billion dollars CVD market value in the United States that year. [Amy Berninger - EBRC] 11:56:58 I figure that is projected to top 25 billion by 2025. 44% of regular CBD users spend between 20 and $80 per month on CBD products and 13% spend more than $160 per month. [Amy Berninger - EBRC] 11:57:13 Next slide, please. [Amy Berninger - EBRC] 11:57:22 As you can see, there's a variety of different over the counter CVD products that are available to consumers. [Amy Berninger - EBRC] 11:57:28 CBD oil or gummies are probably the 2 most common products that most people think of when they hear CBD. [Amy Berninger - EBRC] 11:57:34 However, there are many others. For example, CBD can be consumed in a variety of different food and beverages project. [Amy Berninger - EBRC] 11:57:41 Products such as T. It can be applied topically as a cream or a lotion and it is even found in some cosmetic products. [Amy Berninger - EBRC] 11:57:48 It can also be smoked using different mechanisms and inserted or instilled into specific areas of the body in the forms of eye drops and suppositories. [Amy Berninger - EBRC] 11:57:56 And in fact, as Personal mentioned, there are even CVD products for pets now. [Amy Berninger - EBRC] 11:58:01 Next slide, please. [Amy Berninger - EBRC] 11:58:04 The use of pure CBD can cause common side effects and adverse reactions in some people. Some of the most common adverse reactions are those experienced by 10% or more of users. [Amy Berninger - EBRC] 11:58:14 Is that are observed with CBD with pure CBD include drowsiness and or fatigue decreased appetite, diarrhea, increased liver enzymes, rash, insomnia, and other sleep disorders and infections. [Amy Berninger - EBRC] 11:58:27 These adverse reactions are similar to some of those associated with other anti-apoleptic drugs. Next slide, please. [Amy Berninger - EBRC] 11:58:40 Next slide. [Amy Berninger - EBRC] 11:58:49 So in addition to the potential adverse effects of using pure CBD, the use of over-the-counter CVD products pose additional threats to consumers and we're going to spend a little bit of time talking about those. [Amy Berninger - EBRC] 11:59:03 So in addition to the potential adverse effects associated with pure CVD, CBD may also produce psychotic effects or cognitive impairment in individuals who regularly use Delta 9 PHC products like marijuana. [Amy Berninger - EBRC] 11:59:18 Factors influencing the likelihood of CBD associated adverse events and or side effects. Include the strength and purity of the product. [Amy Berninger - EBRC] 11:59:25 The amount used, the mode of administration, concurrent substance use and misuse such as legal and illegal drugs and alcohol and interactions with prescribed drugs or other medications. [Amy Berninger - EBRC] 11:59:38 The labeling of over the counter CVD products may also put consumers at risk. Research suggests that the labels concentration of these products are unreliable and that they may attain more or less CVD than labeled. [Amy Berninger - EBRC] 11:59:49 For example, one study found that among 84 CBD extracts purchased online from 31 companies, the CBD concentration was only labeled accurately in 31% of products. [Amy Berninger - EBRC] 12:00:00 Almost 43% of products were underlabeled and 26% were over-labeled. [Amy Berninger - EBRC] 12:00:05 Further, the FDA does not inspect the manufacturing facilities that are used to produce non FDA approved CBD products. [Amy Berninger - EBRC] 12:00:12 Therefore, these products may be produced using unsafe manufacturing practices and without adequate process controls in place. Therefore, they may contain biological and chemical contaminants such as pesticides, heavy metals, bacteria, and fungus. [Amy Berninger - EBRC] 12:00:26 All which pose health habits to those who use them, especially in young children and pets. [Amy Berninger - EBRC] 12:00:32 One of the contaminants or additives that may be present in a label. Is unlabeled delta 9 or delta 8. [Amy Berninger - EBRC] 12:00:39 PHC. The previously mentioned study of 84 commercial CVD extracts also found that over 21% of the samples tested contained unlabeled delta 9 THC and another study found that 12% of hemp oil products available commercially exceeded the 0 point 3% THC concentration limit. [Amy Berninger - EBRC] 12:00:58 Thus, consumers who use CBD products that claim they do not contain Delta 9 THC may still screen positive for marijuana. [Amy Berninger - EBRC] 12:01:05 Unclear or misleading labeling may also pose work related legal and health risks. Moreover, like CBD, products that contain Delta A T HC are now available for purchase online and in stores. [Amy Berninger - EBRC] 12:01:18 And are also being marketed for a range of health conditions. However, these products have not been evaluated by the FDA and are not considered safe to use. [Amy Berninger - EBRC] 12:01:27 One of the greatest concerns around Delta HTTC product products is Is that individuals who use them may be misled to believe that they do not have any intoxicating properties because they are labeled as a hemp product. [Amy Berninger - EBRC] 12:01:39 There are also concerns around Delta A T HC product formulations, purity and dosage, unintentional product exposure to children and pets, and potential adverse effects such as vomiting, hallucinations, and loss of consciousness. [Amy Berninger - EBRC] 12:01:52 The potential adverse effects associated with mislabeled CVD products may be contributing to the increasing number of CVD-related emergency room visits. [Amy Berninger - EBRC] 12:02:00 Literature on this topic is sparse, but growing. For example, a paper published in clinical toxicology in 2,023 examined CBD exposures documented by. [Amy Berninger - EBRC] 12:02:13 2,023 examined CBD exposures documented by America's poisonous CBD exposures documented by America's poison centers. [Amy Berninger - EBRC] 12:02:13 This study identified an increasing trend in CBD exposure cases managed by poison centers and serious medical outcomes in temporal association with exposures to non FDA approved CVD products. [Amy Berninger - EBRC] 12:02:24 The findings also suggest both unintentional and intentional use of FDA approved. Not FDA approved CBD by children. [Amy Berninger - EBRC] 12:02:33 Finally, individuals who purchase over-the-counter CVD products may do so for various health conditions despite limited evidence of effectiveness or safety. [Amy Berninger - EBRC] 12:02:41 Unaware that they may contain impurities in different CVD doses than using clinical studies with pure CBD. [Amy Berninger - EBRC] 12:02:48 As a result, they may assume that they are effectively treating their medical condition and determine it is necessary. It is unnecessary to consult with a health care provider or seek medical care, which may delay the receipt of accurate diagnosis and treatment. [Amy Berninger - EBRC] 12:03:03 Next slide, please. [Amy Berninger - EBRC] 12:03:07 A special concern to the medical community is CBD used by pregnant and breastfeeding women and by children. [Amy Berninger - EBRC] 12:03:13 There's not enough evidence to suggest that CBD useful pregnant is safe. Both Delta 9 THC and TBD cross the placenta and can impact the fetus directly. [Amy Berninger - EBRC] 12:03:23 For example, one study detected CVD in the Stool of Newports. In addition, although the precise mechanisms are not fully known, it is agreed that the endocannabinoid system is important in reproduction. [Amy Berninger - EBRC] 12:03:35 And the endocannabinoid receptors through which cannabinoid like CBD Act were also expressed throughout the placenta. [Amy Berninger - EBRC] 12:03:43 This suggests that there may be indirect effects of in Euro canavanoid exposure from the placenta. [Amy Berninger - EBRC] 12:03:49 CBD that is contaminated with THC can result in additional harm. In utero THC exposure can affect the baby's brain development in the womb and increases the likelihood of still birth or premature birth. [Amy Berninger - EBRC] 12:04:01 Can be passed on to an event through breast milk and experts think this may also be true for CBD. [Amy Berninger - EBRC] 12:04:07 Intentional and unintentional CBD used by children is also a concern. There has been an increase in CBD poisoning cases in children after eating edibles or overdosing on adult on an adult product such as gummies that belong to a parent or caregiver, which may be mistaken for regular candy. [Amy Berninger - EBRC] 12:04:24 Emergency room visits by children for CBD intoxication are also increasing as the use of CDB products increases by adults, especially edibles, unintentional CBD. [Amy Berninger - EBRC] 12:04:35 Intoxication in children will likely increase as well. [Amy Berninger - EBRC] 12:04:40 Next slide. And then for the next slide, I'm gonna hand it back to Krishna. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:02 Thank you, Amy. Sorry about the. My mouse is acting up. I refuse to refuse to advance lights in some places. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:11 So I'd like to summarize and draw some concluding remarks from what, Amy just, eloquently, described. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:19 CBD has become increasingly available and marketed since the 2,018 farm bill. Was passed. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:27 CBD sold and used in various forms. From eating and drinking to smoking and vaping. It's even available for pets. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:34 However, there's only one FTA approved CPD product. For treatment of seizures associated with certain rare syndromes in patients one year of age and older. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:46 Who have not responded to conventional therapy. This purified product is available in a reliable dosage form. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:05:57 And a reproducible route of delivery. Otherwise, the FDA has not approved any over the counter CBD product as a food. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:06:05 Additive, nutritional supplement, our treatment for any physical or mental condition. Instead, it has concluded that existing regulatory frameworks for foods and supplements Do not apply to CBD and a new pathway has to be found. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:06:24 Nevertheless, CBD is marketed for a number of ailments. Despite limited Evan's of effectiveness. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:06:32 The CBD marketplace. Is largely under regulated. Leaving it up to the consumers. To do their own research. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:06:41 Buyer the where you know if it's too good to be true etc. Medical fraud is only too common with advertisements. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:06:50 Claiming it is perfectly safe and legal. And can treat whatever isailing you. Yet, interest in CBD is increasing across all age groups. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:02 And use for pets is also mushrooming. Consumer demand for CDVD has increased due to aggressive marketing. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:11 And false health claims. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:16 Commercial grades are over the counter OTCCBD has questionable label and purity as Amy illustrated with several examples. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:25 Biological and chemical contaminants have been found in many samples such as heavy metals including copper, nickel, lead. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:34 Pesticides, bacteria, fungus and mold. Moreover, many CVD products were found to have more or less than the advertised amount of CBT on the label. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:46 Where's the complicating this matter? Is that CBD may also contain delta 8 and or delta 9 despite not being listed on the label. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:07:56 Use of such products may produce unintended intoxication and potential run-ins with the law. Children are especially vulnerable to intoxication and parents must talk to their children. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:10 About the risks and harms of using products that contain CBD. And not allow their children to use over the counter CBD products. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:20 Baron should keep CBD products away from toddlers. We may eat their parents cookies and our gummies. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:27 With tragic consequences. There been reports of babysitters giving these gummies to little kids not knowing it had CBD or cannabis in it. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:37 Pregnant and breastfeeding women should also be advised to avoid CBD products as its effect. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:43 On developing fetus and child is still being evaluated. Studies, some test animals to produce medical issues. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:08:52 The FDA or just women not to use cannabis or any type of CBD product. While [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:09:00 It could be dangerous for mother and child. With these important take home messages, I'd like to turn the meeting over to him better too for his closing thoughts. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:14 Thanks a lot of Krishna and Amy, for, presenting the webinar and I would like to thank you all for today's presentation. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:24 So if you'd like to learn more about information presenter today, you can download the advisor for free from the SAMS to store and the EBPFCU sites. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:34 Or you can email the same. So, the, team at the address provided here on this slide. And we will be happy to answer your questions. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:44 And we will be happy to answer your questions or connect you with the presenters or connect you with the presenters if you have specific questions. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:47 Or connect you with the presenters if you have specific questions. So, or connect you with the presenters if you have specific questions. [Carvalho, Humberto (SAMHSA/OIEA)] 12:09:52 So I'd like to thank you again for participating and I'm turning back to Ben [Van Wilson - PTTC NCO] 12:09:55 I didn't like to just think our presenters for such great information today. We've been at about a thousand attendees. [Van Wilson - PTTC NCO] 12:10:04 Since, just since we began. We are answering questions here in the chat. [Van Wilson - PTTC NCO] 12:10:11 One by one we've made them visible to folks so you can upload them there I'm gonna just, direct you to a number of the resources that I dropped into the chat. [Van Wilson - PTTC NCO] 12:10:26 A moment ago, the link to the advisory. I'll put in there one more time for everybody. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:10:35 You want to take over, then? [Van Wilson - PTTC NCO] 12:10:38 Yeah, oh for the slides. Yes, thank you. [Van Wilson - PTTC NCO] 12:10:50 I'm gonna purposely take my time here. So we can get to. Many questions as we can. [Van Wilson - PTTC NCO] 12:11:01 Also going to put in the chat the link to our survey today. [Van Wilson - PTTC NCO] 12:11:10 We graciously ask for a few minutes of your time to just tell us how today went. [Van Wilson - PTTC NCO] 12:11:23 I'm gonna put today's slides in the chat here as well. I'm just keeping one eye on our QA. [Van Wilson - PTTC NCO] 12:11:30 Here we've got a number of our other team members here, Scott and Brittany. As well as Taylor, Deborah. [Van Wilson - PTTC NCO] 12:11:40 Michelle, Jane. And Susie who really formed the backbone. The PTC prevention, cannabis prevention working group. [Van Wilson - PTTC NCO] 12:11:52 I know that they're helping answered a number of the questions here in the chat. [Van Wilson - PTTC NCO] 12:12:00 Again, I'll put our survey. You're in the chat. [Van Wilson - PTTC NCO] 12:12:06 And as I mentioned a couple times, our next steps within a week. Today's recording will be on the PTC network. [Van Wilson - PTTC NCO] 12:12:13 Working group page, cannabis prevention working group page. And I'll send you a follow up email with instructions on how to access your. [Van Wilson - PTTC NCO] 12:12:22 Certificate. [Van Wilson - PTTC NCO] 12:12:25 This is a quick tease for our next webinar with the Cannabis Prevention Working Group. On cannabis and pregnancy. [Van Wilson - PTTC NCO] 12:12:32 And I'm going to put the link to sign up to. SPEAKER. Newsletter monthly newsletter. [Van Wilson - PTTC NCO] 12:12:43 We use this same list to. Communicate about all of our upcoming. Work group events and so if you're on our PTC post subscription list you will get the email to register for our next webinar. [Van Wilson - PTTC NCO] 12:13:04 Since we're a little ahead of time here. I'm gonna just put our survey in one more time if anybody is not able to stay with us. [Van Wilson - PTTC NCO] 12:13:11 We do have a few questions. That I have that kind of risen to the top here in our QA chat. [Van Wilson - PTTC NCO] 12:13:18 And Scott, Brittany, Christian and Amy, I'll just ask you just a few minutes. [Van Wilson - PTTC NCO] 12:13:24 If we can speak to a couple questions here and Krishna and I suspect. That you have the most knowledge on this. [Van Wilson - PTTC NCO] 12:13:32 As one of the primary authors here at the advisory. So just off the top, I shared a couple here with our hosts. [Van Wilson - PTTC NCO] 12:13:39 First question. If you're able, can you speak quickly to the difference between pure CBD and commercial CBD? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:13:48 Yes. Pure CBD is just then. There's nothing else in there. It was the molecule that I showed the second molecule from the left. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:13:58 And commercial CPD. I only knows what's in it. It's not regulated. Nobody knows how it's made. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:14:08 Regulated. Nobody knows how it's made, except the manufacturer. The purity is unclear Unless you take it to the laboratory yourself. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:14:17 You wonder what's in it. [Van Wilson - PTTC NCO] 12:14:21 Thanks Christian. Let me pull up one more here that I highlighted. [Van Wilson - PTTC NCO] 12:14:27 Alright, if you're able to address it, what's the reason that there are so few FDA approved CBD products and is the FDA working towards approving more? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:14:37 I'm sorry, it can someone else answer it or you want me to check? [Van Wilson - PTTC NCO] 12:14:37 I know. No, go ahead. Please jump in. I know we don't have anybody on here from the FDA today, so. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:14:44 Alright, now the FDA approval process is pretty lengthy. And you know you have to invest money and show that it's it works for what you claim it works and it's better than either a placebo or other conventional medicines that are used for that. [Van Wilson - PTTC NCO] 12:14:45 Directly. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:01 Gibbon problem and nobody seems to have stepped up to the plate and done randomized control trials which are expensive and lengthy. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:08 And FDA for that to prove and FDA usually does not get into this business of approving supplements anyway. [Van Wilson - PTTC NCO] 12:15:18 Yeah, that's. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:19 It's assumed it's safe and they will step in if problems are found with it. So if medical claims are made for a product, then the FDA will step in. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:32 That's why a lot of vitamins and other things you may see that the FDA has not. [Van Wilson - PTTC NCO] 12:15:33 Not good. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:40 It's not an FDA pro product for this for cheating any condition. [Van Wilson - PTTC NCO] 12:15:46 Thank you, Krishna. I'm seeing a couple of questions here just at some surprise about CBD being in the same family as hops. [Van Wilson - PTTC NCO] 12:15:55 Can you say more about that? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:15:56 It just, that's how it is. Biology is biology. I don't know what else to say. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:16:03 Opposite in the same family. Family is is a wide encompassing term in in cell biology unless they've come up with new things since I studied this 20 years ago. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:16:18 You have the species and then you have the genus. Cannabis is a genus and above. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:16:23 Can, is. Class and above classes family. So you have all these different branches coming off from this family tree, if you will, and hops happens to be one of those branches. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:16:38 There's some mulberries that are also in the same family. I can't remember which one. [Van Wilson - PTTC NCO] 12:16:44 Thank you, Krishna. I'll just invite. Brittany or Scott, were there any questions that you are seeing here? [Van Wilson - PTTC NCO] 12:16:54 That you think we should. Pull up for our panelists today. [Scott Gagnon - NE PTTC] 12:16:58 Well, I can just, I answered it in the tab or in the question, but someone was asking about, states that, excuse me, that have legalized. [Scott Gagnon - NE PTTC] 12:17:07 And whether what's in the laws or the regulations around CBD and I put a response but just for everyone's benefit. [Scott Gagnon - NE PTTC] 12:17:15 You know, by and large, don't tend to put a lot of focus on CBD. [Scott Gagnon - NE PTTC] 12:17:19 There's a lot more focus on TC when they're writing their. The regulations. I've asked you, you might have some language that pertains to like labeling and packaging in terms of content. [Scott Gagnon - NE PTTC] 12:17:28 But in terms of like how much CBD can be in a product. Or anything like that that I'm aware of anyway there's not many states that really Really tend to address that frankly they don't really there very few states that even address TAC content and they're underlaws to that matter so I just wanted to answer that for the benefit of the group. [Van Wilson - PTTC NCO] 12:17:52 Thank you. Scott. There's a couple questions here that I think are really interesting. I don't know if we'll be able to speak to them or, you'll be able to speak to them. [Van Wilson - PTTC NCO] 12:18:04 I thought this one was interesting. This is from Ramona. She says a licensed pharmacist in my area creates his own CBD oil for sale. [Van Wilson - PTTC NCO] 12:18:11 Should this be considered safer than what you were referring to is over the counter CBD? Have to speculate perhaps and maybe you don't want to do that so What do you think? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:18:20 Depends on your pharmacist. How well do you trust him or her? [Van Wilson - PTTC NCO] 12:18:23 Okay. [Van Wilson - PTTC NCO] 12:18:27 There's another one here. I think you can probably speak to this a bit more, but, Sarah, our user says, do you think the blip in the slides may have, caused us not to cover an interaction with CBD and medications. [Van Wilson - PTTC NCO] 12:18:41 Can we please speak to concerns about CBD and medication interactions. I'm sure that that's a Now we got a lot of up votes on that one. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:18:51 You want to answer that Amy or do you want me to do it? [Amy Berninger - EBRC] 12:18:56 I, you can take them. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:18:57 Okay, the last time I checked yes, there are many many medications that that interact with see I don't remember all of the list the number the number I saw there's a very nice website called drugs. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:19:06 Dot com. And they claim it's almost 600 the list. I don't remember all of them. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:19:14 Actually, I don't remember any of them. But it's huge. The number of, drugs. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:19:22 But by drugs, they mean both listed and illicit drugs that interact with. [Van Wilson - PTTC NCO] 12:19:26 In our registration this was a question that we had received a number of times as well. And I think the answer is you'll have to look for your specific medication. [Van Wilson - PTTC NCO] 12:19:37 Because there are so many that might potentially interact. [Van Wilson - PTTC NCO] 12:19:43 Any last questions from our team? [Van Wilson - PTTC NCO] 12:19:54 Scrolling through our list here. [Van Wilson - PTTC NCO] 12:19:58 Oh, this is a really interesting one. Who is regulating CBD infused alcohol? This is a really trending issue. [Van Wilson - PTTC NCO] 12:20:06 Any knowledge on that from our group? [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:20:10 I don't know if anybody is. [Van Wilson - PTTC NCO] 12:20:15 Hmm. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:20:19 I think. [Scott Gagnon - NE PTTC] 12:20:19 I mean, I would think I would think the source matters if it's from a. [Scott Gagnon - NE PTTC] 12:20:25 If it's from. Yeah, I think it just depends on the sort of the CV. Is coming from a state regulated or state legalized. [Scott Gagnon - NE PTTC] 12:20:33 Operators in the state. Here we could regulate it and wanted to. [Scott Gagnon - NE PTTC] 12:20:42 I don't think any state does. [Van Wilson - PTTC NCO] 12:20:45 See somebody shared in the chat that Washington state just passed on the prohibit. Alcohol and cannabis products. [Scott Gagnon - NE PTTC] 12:20:49 Well, there you go. [Scott Gagnon - NE PTTC] 12:20:53 Go Washington. [Van Wilson - PTTC NCO] 12:20:53 So it is emerging. And I think that speaks to the interest in today's webinar. We're still at 950 people with us. Which is. [Van Wilson - PTTC NCO] 12:21:05 Consistency that I haven't seen, across dozens of webinars that I've done in the last number of years here so Clearly the interest is high. [Van Wilson - PTTC NCO] 12:21:13 As I'm Berto noted. We will do our best to kind of digest the questions. [Van Wilson - PTTC NCO] 12:21:22 The comments, the feedback that we've received today and respond appropriately both through the PTC and the feedback that we've received today and respond appropriately both through the PTTC and through federal SAMSA channels as well. [Van Wilson - PTTC NCO] 12:21:33 So again, I just want to. [Van Wilson - PTTC NCO] 12:21:36 Direct you to the survey first, but then in our last few minutes here in the chat, I'm gonna turn it back on here. [Van Wilson - PTTC NCO] 12:21:44 This is a bad idea, but I'm gonna do it anyway. In the chat share one thing that you learned today. [Van Wilson - PTTC NCO] 12:21:49 We've got 930 people so prepared for a barrage of chats here. I'll keep it open here for the next 5 min or so, but just in the chat. [Van Wilson - PTTC NCO] 12:21:59 Please share one thing that you've learned. [Van Wilson - PTTC NCO] 12:22:10 And the whole invite. Scott Brittley, our panelists here to just call some out here that you think. [Van Wilson - PTTC NCO] 12:22:17 We need to have underlined on our way out today. A lot on regulation and the lack of regulation. [Van Wilson - PTTC NCO] 12:22:30 Options in the same family. [Britany Wiele - PSW PTTC] 12:22:31 Saw some concerns about contamination. The chat's just moving so fast. [Van Wilson - PTTC NCO] 12:22:38 I know it's fine. It's really fun. The harms of breastfeeding mothers. [Britany Wiele - PSW PTTC] 12:22:39 Yeah. [Britany Wiele - PSW PTTC] 12:22:43 I'm saying the word contamination. Regularly so I think that's the one that bubbled up to the surface. [Scott Gagnon - NE PTTC] 12:22:49 Is it probably good to, to say that we have another webinar coming up in September where we are focusing on. [Scott Gagnon - NE PTTC] 12:22:56 Cannabis and pregnancy. So I don't know if we're, how deep we're diving into that, but. [Scott Gagnon - NE PTTC] 12:23:01 If you wanna register for that, maybe we can answer that question. [Britany Wiele - PSW PTTC] 12:23:04 Yeah, that's a great point. There are a lot of. And pregnancy related questions that are popping up and we will be having a webinar next month. [Britany Wiele - PSW PTTC] 12:23:12 Focusing on that. [Van Wilson - PTTC NCO] 12:23:14 I'm not gonna attempt to put something in the chat right now, but I did share. The link to subscribe to our monthly PTC post newsletter and that's where you will see the announcement for our pregnancy and cannabis webinar coming up here. [Krishnan Radhakrishnan (SAMHSA/CBHSQ)] 12:23:24 Yeah, I'm. [Van Wilson - PTTC NCO] 12:23:31 What's call out a few more here that we're seeing. [Britany Wiele - PSW PTTC] 12:23:35 I see one that says there's no data to support the benefits of CBD use. [Van Wilson - PTTC NCO] 12:23:41 It's missed record. [Britany Wiele - PSW PTTC] 12:23:41 The difference between THC and CBD. [Van Wilson - PTTC NCO] 12:23:52 How much says that in essence, it's a complete free for all very little if no regulation. [Van Wilson - PTTC NCO] 12:24:00 Not as safe as people think. Contamination. One of the learning objectives that we had for today was that you came away knowing how to speak to this, not only as a substance use preventionist, but in whatever field you might find yourself. [Van Wilson - PTTC NCO] 12:24:15 So. We do see that. There is a lot of nuggets of good information that people are coming away with. [Van Wilson - PTTC NCO] 12:24:24 And the chat is still going here. We still have 830 people with us, which just kind of amazes me. [Van Wilson - PTTC NCO] 12:24:30 But this is really interesting. I really love seeing learning and now the repetition. As adults, I know we need repetition, repetition. [Van Wilson - PTTC NCO] 12:24:41 So I'll give us just another few seconds here. [Van Wilson - PTTC NCO] 12:24:46 And Brittany, I'll hand it over to you just to close this out. [Britany Wiele - PSW PTTC] 12:24:50 Alright, well thank you everyone for joining us today. We're just So glad to see there's so much interest in this. [Britany Wiele - PSW PTTC] 12:24:56 This subject and we're happy that you all were able to join us. Feel free to. [Britany Wiele - PSW PTTC] 12:25:02 Review this presentation it will be on our website in a week or so as well as reviewing the advisory itself and I hope you all have a great day and enjoy. [Britany Wiele - PSW PTTC] 12:25:13 The content that we have for you and we'll see you on our next session