E52 - Prenatal Cannabis Exposure – Dr. Ciara Torres

Let us start by saying, we encourage pregnant women toward balanced diets, proper exercise, and we discourage unnecessary drug and alcohol use.  But, what if a mother consumes cannabis during pregnancy? In this episode Kirk and Trevor begin to explore prenatal cannabis exposure and are joined by Dr. Ciara Torres, Adjunct Assistant Professor in the Department of Psychology at Columbia University.  This neuroscientists near six-year meta-analysis found prenatal use of cannabis does not lead to cognitive impairment of children.  Dr. Torres discusses how her study, published May 2020, offers policy makers a better understanding of how cannabis affects newborns.  Often babies are removed from a family when it is discovered a mother used cannabis during the pregnancy; this action may actually be more harmful than the exposure.  Proper prenatal care is paramount when predicting the future success of an unborn child. This episode is designed to start the debate, so have a listen and offer your feedback by sending us a note to This email address is being protected from spambots. You need JavaScript enabled to view it. 

Episode Transcript

Trevor: Kirk, we're back and you brought us a very interesting lady from the States.

Kirk: Yeah, you know, Trevor, I want to talk a little bit about what this episode means to me here.  We go back to how we started this project. We had our wish list. One of my wish list, was to do an episode on prenatal patients. Cannabis and pregnancy. So, in the last four weeks, I've been doing a lot of research and reading some papers on cannabis and my goal; cannabis and pregnancy. My goal is to start a discussion about cannabis and the influence within my clinical practice. As you know, Trever in this project, we've often tried to find out information about cannabis, how it affects our practice. Cannabis and pregnancy, cannabis and prenatal programs, cannabis and breast feeding is something that I've wanted to touch upon since we started this project. And I need to start as much as we are two men chatting about a woman's issue. I want to state up front personally, women have the right to choose how to treat their body right. So as two men, let's just put that out there. I don't want this, this is not a debate on that. However, as a nurse, I often enter into a long debate of society's responsibility of the unborn child. To the extent that we know there's a lot of harm that comes from alcohol. We know that right now the clinical practice, clinical policy is that no alcohol is the best. Back in the day, doctors would recommend Guinness for example. Right. The goodness of Guinness would help a mother with breast feeding. What we now know through research, through studies, through public policy, that alcohol is just bad. And we know I know as a practitioner, I have I have delivered babies where the mother has been drunk. In my practice fetal alcohol spectrum disorder is a big part of my practice. Unfortunately, I work in corrections. I have worked in corrections. And as we know, a great body of the inmates, a high percentage of inmates can be put on the spectrum of fetal alcohol spectrum disorder. So, I have input on that. I have knowledge about that. And so let's start this whole conversation that the best thing for a mother, a pregnant woman, is a proper diet and all drugs and alcohol off the table, right? 

Trevor: That's not controversial.

Kirk: Yeah, that's not controversial. So let's start the conversation by that. I recommend that. I understand that. That's important to me. Many years ago, but 20 years ago and as you know, through our discussions, I've been very curious about cannabis. And I can remember reading an article and we called it the Jamaican study. And Dr. Torres.

Trevor: She called it, exactly the same thing.

Kirk: Yeah. Yeah. So it was kind of cool because I remember reading the Jamaican study and this is a very small study done by Dr. Melanie Dreher And I have reached out to her. I have reached out to her and I think she's in retirement mode. But I've reached out to that study to talk to her. I've reached out to many, many, many authors in the last four weeks of studying this episode. And so my understanding of cannabis and prenatal started with the Jamaican studies. And the irony is that in the last 20 years, I've never seen anybody refer to it in clinical practice. And I've always wondered why. Now, one of the reasons, of course, is that it's a it's a very small sample size of the study has thirty-three mothers that were using cannabis and drinking tea and twenty-seven non-users.  What made this an interesting study for me back in the day was that it was very easy for the researchers to isolate the sample of those that do cannabis, those that don't, because one of the biggest problems in research cannabis is the fact that many of the sample sizes people drink alcohol, people smoke cigarettes, people might have anti-depressants. People have socio-economic issues, low income, low education, low socio-economic standing. And so it's very difficult to isolate cannabis and a mother's relationship. We found somebody, doctor, Dr. Cierra Torres, who basically went out there and started with fifteen hundred studies, narrowed it down to forty-five studies. And she has isolated the relationship between cannabis and the mother and removing the other factors. And it's come down to the fact that they don't necessarily see any difference in cognitive behavior of the baby.

Trevor: And I'm just going to jump in just and she touches on this, too. But so, what she did was called a meta-analysis, which is good. It's just so but a study of studies, meaning she didn't, and we'll get to a reason why she can't. But she didn't take twelve hundred pregnant mothers and give them cannabis and twelve hundred pregnant mothers and give them something else like smoking that seemed like cannabis. This was not a double blind, placebo-controlled trial. And it wasn't also what we call a natural experiment where, you know, let's say New Jersey legalized recreational cannabis. So, you had a whole bunch of mothers self-declaring they're using cannabis where next door in New York, it wasn't. So, it wasn't a study of participants, which is kind of our gold standard. But on the other hand, it's as she mentioned, you know, she used to do experiments on rats where she could control everything. You can't do that in people. With people it's hard. You have to sort of take as much as you can and then apply some fancy stats to it.

Kirk: But she was able to she was able to go back to those studies and remove the correlation between the low socioeconomics, low education, and just isolate, if you look at cannabis and pregnancy, are there any correlation between the cognitive, the cognitive ability of the child later. And the reason why this is important to me, because a lot of the literature that's out there for me to practice, for my practice is that all drugs and all alcohol is bad. Right now, we've said that already the best thing for a mother is a balanced diet and no drugs or alcohol. But what was happening is that when women were, when women, not when, but when a woman says that she identifies as a cannabis user, some of those women were losing their babies and what they were able to find out and this is another study, like I said Trevor, I've reached out to several studies here. One of the studies on this topic that I've reached out, and this is by Dr. Mark and Dr. Turpin, they did a study on cannabis in pregnancy, maternal child health implications during a period of drug policy liberation.  And what they found out is that women that identified as being cannabis smokers we're having the children removed and then following those children and discovering that by going into the system, there may be more harm done by removing a child from a pot smoking mother, that there is more harm doing that than the mother who smoked pot in pregnancy. The point is, is that with this episode, I want to start the discussion. Obviously, we need more, obviously, and we need more studies. Right? Obviously. And Dr. Torres talks about that. We need more studies. But what she does come out to say is that maybe some of the public policies that are out there right now might be a little bit.

Trevor: Draconian.

Kirk: Yeah, yeah. When it comes to cannabis. Right. Going back to going back to the Jamaican studies, what makes that study very unique, and Dr. Torres talks about it, but we never really discussed she talks about it being unique because it's outside of Canada, outside of the United States and Canada. What I think the reason why it makes it unique is because they've been naturally able to remove all the other criteria. No one is snorting coke in this in this cohort. This is a cohort of cannabis versus non-cannabis and following these children over the last 20 years and there's been successive studies on it. She says she went back to forty-five studies and she later says that with those forty-five studies it goes back to.

Trevor: In the 70s it was from the 70s till today.

Kirk: So they're following it. So essentially what they're finding is that when it comes to cannabis, removing all of the social economics, cannabis may not be as harmful to babies as we thought. This is why I wanted to bring this forward. This is why this is an important tool.

Trevor: All right. And you know what? I think that's enough preamble. Let's let Dr. Torres.

Dr. Torres: So my name is Sierra. I'm a neuroscientist and I also teach at Columbia University in the Department of Psychology. And my area of focus is recreational drugs and more recently, specifically, marijuana.

Kirk: OK, wonderful. And your background, you have a Ph.D.?

Dr. Torres: Yes, I have a Ph.D. in neuroscience.

Kirk: OK. And some of your research has been in cannabis. How did you fall into becoming a cannabis researcher?

Dr. Torres: So we kind of fell into it and in two main ways. One of them kind of the less interesting way is that just because cannabis is the most commonly used illicit drug. So that's obviously just makes it interesting just because of that. But more interestingly, because I heard at some point in the middle of my PhD that sometimes a positive drug test for a woman that just gave birth for marijuana is enough to separate the family from the newborn baby. So, if the mother has exposed through pregnancy the baby to marijuana, that's kind of seen enough to accuse the mother of medical neglect or abuse. So that was kind of part of the inspiration for the paper. And the idea was, well, you know, do we really kind of have evidence suggesting that we really, really need to be that worried about prenatal marijuana exposure to be able to warrant families being separated from newborns? So that's kind of how it started.

Kirk: OK, that's actually quite interesting. So, you were you were doing your PhD and you discovered that women were being harmed by the law, I guess, the justice system, because they declared that they were consuming cannabis. So that got you into studying cannabis and pregnancy. So where is your discovery taken you? What have you discovered?

Dr. Torres: So, we wanted to basically. We look at this question systematically in a way, because, as you might know, if you just choose one study, you might have an answer of, yes, there's an effect if you get another study, no, there's not an effect. So instead of looking at one individual study versus the other, we wanted to take the entire literature, every study that had ever been done on this particular topic and see what the summary is really after decades of research on the topic. And let me clarify that there's many potential effects that marijuana can have in and out of pregnancy. But the one that I did look at specifically was the effect of prenatal cannabis exposure on cognition specifically.

Kirk: OK, and what did you discover?

Dr. Torres: Well, I discovered when I took all of that together, we discovered that basically in the overwhelming majority of the cases, that children exposed to marijuana prenatally do not perform any different from children that have not been exposed to marijuana prenatally.

Kirk: That's fascinating. Why is that not out there more?

Dr. Torres: Well, there might be many reasons. First of all, kind of no one had really done a review of this type, right? If it had been done, we wouldn't have done it ourselves, of course. So that's one reason. The other reason is maybe that it's obviously not a popular kind of fact to have out there.

Kirk: Right. Or what did you do this paper when was the paper dated.

Dr. Torres: I believe was May 8th of this year.

Kirk: 2020, so this is brand new. This is brand new. So, you're getting much attention.

Dr. Torres: Yeah, there's been some attention. I already did an interview with the Chronicle of Social Change in Texas. And I also was interviewed recently by Forbes.

Kirk: Right. And I've read that article. That's a fascinating article. I'd like to stay a little longer on the cannabis. I've been nursing some, I guess, 30 more than 30 years, almost 40 years. And I remember back in the 90s, Dr. Melody Dryer, you did a lot of research. Do you remember her paper at all? She did the Jamaican study.

Dr. Torres: Yeah. Yeah, I do remember.

Kirk: Yeah. I was always very curious because I've raised that I've raised that study with many people over the years about it being significant because it was a specific audience. They were able to actually you've got one group that's been cannabis exposed and one group that's not; albeit a small group. Did you find other studies like that?

Dr. Torres: Oh, yeah, yeah, yeah. So, in the paper that we published that addresses all of the literature, I think we ended up with forty-five separate studies. How you call it the Jamaican study, and I'm laughing because that's how we also know it as a Jamaican study. And we do know as we're Jamaican study because it's so uncommon in the literature to have any kind of studies going on outside of North America. So US and Canada. So I really appreciated that one of the studies was done somewhere else, you know, because kind of all of the ideas that we have on this topic come from Canada and the US when there's so many countries out there, obviously. Right. So, we definitely do have to expand to other places, to other cultures, to everywhere. Right. Not just stay in this part of the world.

Kirk: Mm hmm. What were some of the limiting issues you found in some of the studies? And I mean by that, I guess using the Jamaican study as our foundation, because it's so it's so easy to depicts a population of cannabis users against the non. Did you find that there was a blend of other drugs and alcohol abuse that went in with the cannabis? So when people said, you know, drugs are affecting babies, they just they did a cauldron of stuff were they able to pinpoint cannabis in the studies you looked at.

Dr. Torres: So, as you said, many of the people that use cannabis might use other drugs and that might include something, some things that we normally don't even think about as drugs. Right. So, alcohol and tobacco being the main ones that because they're so socially acceptable, we don't think about it as drugs, but they are. Right. So it's definitely very common for the participants in these studies to be using other drugs. The way that researchers, kind of deal with that is that they use kind of statistical methods of data analysis to be able to, as best as they can, separate what they think is the contributing kind of effect of these different other factors. And that just doesn't include drugs, because, of course, we can fall in the trap of thinking, well, we only have to control for other drugs, but that's not true. We have to control for socioeconomic status. We have to control for the home environment. We have to control for the education of the mother, of the father. How many people live in the house? There's all these factors that are contributing even separately from other drugs that we're considering.

Kirk: Right. So in your in your study, you're able to do that and basically come up that if you look at cannabis and pregnancy is two relationships, there's no evidence to suggest as an impairment to the baby cognitively.

Dr. Torres: So we didn't because we didn't engage with the actual participants, the mothers and their children. We didn't do that ourselves. What we did was evaluate how the researchers that did those experiments, how did they come up with these conclusions? Right. So if you're telling me something like prenatal marijuana exposure, it decreases attention right on the child. I'm going to be then able to look at that paper and say, well, did you really take into account, that they also smoked tobacco or did you not take it into account? And if you then take it into account, then that is something that I can that I definitely noted in my own paper. Right. To say this is the conclusion. But is it really a conclusion when this was not controlled for or this was not taken into account.  

Kirk: OK, all right. So, you're able to do that. So, when I look at when I look at and I'm just scrolling here, you can still see me. I assume I'm scrolling and I'm looking at I'm looking at the Canadian the Canadian Center of Substance Use and Addiction. And they're basically "Clearing the smoke cannabis," they're making statements such as cannabis is listed as the drug most commonly used, as you said, there are frequent uses of cannabis is associated with low birth weight and parts of the cluster of risk factors correlate with adverse birth outcomes. Now, you didn't find any of that in your studies.

Dr. Torres: So I was not focusing on that. I was only on cognition. There are reviews about that. But every kind of piece should be evaluated very differently. Right. So let's say that I do not find any association between prenatal cannabis exposure on cognition that doesn't necessarily rule out that another potential relationship might be found. So all of these things need to be taken separately.

Kirk: OK. All right. And you also found in your study about the, I guess, social determinants of health. We kind of touched on that, the justice system. Tell me a little bit about that study, how you've discovered women, women in the justice system who have who have admitted to cannabis smoking.

Dr. Torres: Oh, so I didn't do that, particularly in the study, because this study was not about that. I just know that anecdotally, I know that this is happening, for example, in New York City, this is where I was when I originally learned about this. And I did learn about it through the national advocates for pregnant women. Where it's a lot of women in New York City who might lose their newborn children because of positive drug tests. I also eventually got actually involved in these cases because sometimes the judges that are involved in these cases want an expert witness to kind of talk about, well, what does prenatal cannabis exposure do? Because I'm saying that this women, this woman neglected or abuse her newborn because she exposed them to cannabis. So basically, through those experiences of being an expert witness for these cases, I was able to learn more about that particular topic and of course, use what I was finding in my study of the scientific evidence on it to write letters to the judge that are working on these cases and kind of help in that way.

Kirk: OK, where do you think your study is going to do? How is it going to go forward? How do you think it's going to affect health care, I guess?

Dr. Torres: Well, I don't know what it's going to do, because in the ideal world, of course, I would say something like I hope that the scientific evidence does something so that public policy is aligned with it. Right. That's what the ideal would be. But that doesn't always happen. Right. As we know, studies come out every day. Right. And we all like to think of the idea that public policy is aligned with science, but that's not necessarily true. If it were, we wouldn't be having situations like mothers being separated from their babies because of a positive marijuana test. So that would be kind of the ideal. But another thing that I'm hoping that comes out of this particular study is that another thing that we did evaluate was even in the minority of the cases, when there is an association between prenatal cannabis exposure and cognition, what does that mean? Right. Because if I'm telling you that there is a difference, what is that? Right. So, what we were looking at in this paper was when we say a difference and means a statistical difference. Right. So, if I take one, I don't know the third floor in your building. Right. Everyone that lives on the third floor and everyone that lives on the second floor, they might have different IQ that might just happen. Maybe your floor has a higher IQ than the other floor and that would give a statistical difference. However, does that mean that one of the two floors with the lower scores needs help to improve their cognitive scores, their IQ? Not necessarily, right. So that's the difference between what we call statistical difference versus clinical difference. So, a social worker will say, oh, you got a ninety-eight IQ, you don't need help. I don't need to give you therapy because you're still within the normal range. So I'm hoping that from this paper we kind of pay attention more to what a clinical difference means. Am I really seeing that this person is going to have an impairment in their day to day life, or are they going to be able to function even though in general there might be a little higher or a little lower? So that's my kind of second ideal hope with this paper.

Kirk: That you've got a background with mapping the brain and drugs. I was listening to you in another interview. Now, what is that?

Dr. Torres: What do you mean by mapping?

Kirk: Well, I was listening to a podcast and basically were talking about how in your studies, you're looking at how the brain is affected by drugs.

Dr. Torres: So that was long ago in my PhD. So what I was doing back then not related to this paper, but it was also with recreational drugs. I was seeing how amphetamine affected particular areas of the brain if it did or if it did not. So before I got into this project, I was trying to see basically how methamphetamine works in the brain. I would do experiments on a mice, inject them with amphetamine and see if this protein or this molecule on the brain change if it stayed the same. And that's what I did for many years during my PhD.

Kirk: OK. All right. So that has nothing to do with the cannabis story.

Dr. Torres: No, no. So I actually started my drug life with  amphetamines.

Kirk: OK, from your paper. Now, this is the only research you've done specifically on cannabis. Have you done other research?

Dr. Torres: So apart from this huge paper, I've done a couple of letters to the editor, so I don't know if you're familiar with that term. Basically, what we do is we see a literature that has recently been published on these topics and we see if there's any kind of limitations that we're concerned of and including cannabis and other drugs, the limitation that typically comes out is the one that I mentioned. Just because you see a statistical difference doesn't mean there's really a problem.

Kirk: OK, how do I do? I apply the research you've done to my clinical practice? As a nurse, I will have prenatal day and I do prenatal assessments and I do talk about drugs and alcohol, obviously it's part of the tick boxes I go through. How does your research apply to my clinical practice?

Dr. Torres: Well, I think in a way that's kind of limited by where you're practicing, of course, because there are places where kind of the clinicians are left to the side whether they have to report someone or not. Right. Because of a positive drug test or because you suspect that they might be using drugs, even apart from actual toxicological report. So if you are in a place like that, then I mean, I would think that if you already know that the medical professionals are determining that a baby is healthy. Right. There's really nothing to do just because someone might be using drugs. But I do recognize that there are many places where clinicians are basically mandated to report whether they suspect something like that. And, of course, there is a toxicology to prove it.

Kirk: OK, so that goes back to policy. You're saying that hopefully, hopefully studies can dictate public policies would go far enough?

Dr. Torres: Hopefully, yeah.

Kirk: And I guess just as a practitioner, my relationship with the patient, I might share the data as I understand it, but I still have to follow the employer policy, I guess.

Dr. Torres: Of course. I mean, if you have a situation where you're not mandated, of course. And you happen to come upon a patient who admits to you, yes, I smoked marijuana one time five months ago in the middle of my pregnancy, you can use something like this when you put it. We tried to write it, of course, as much layman terms as possible. You can bear this to, I would hope, make the person feel better. You know, that just because they smoked one time five months ago during pregnancy doesn't mean the baby's going to be unhealthy, basically. Right.

Kirk: OK, that's and that's sort of what I was looking for. Is there anything I didn't ask you about your paper about relationship with cannabis and how pregnant women were to give advice to pregnant women? What would your advice be?

Dr. Torres: I mean, I tried to refrain from giving advice because, you know, I think it's a personal decision. Whatever you're doing during pregnancy. I do think that it's important, however, to recognize that apart from cannabis, there are many things that could affect pregnancy, right. If you're not sleeping the right way. If you're not eating the right way. If you're smoking too much tobacco.  If you're doing whatever is just one of the potential factors that could affect anything and everything really with anything depends on how much you do it right. You take too many Tylenol,  one Tylenol enough you could technically damage your liver or you could have some sort of overdose. So dose is really, really important as well.

Kirk: Dosing. Explain it to me.

Dr. Torres: So what I mean is, for example, alcohol, if you take a glass of alcohol and that's going to be a totally different experience than if you take two gallons of alcohol within an hour, you know, it could really be the difference between just feeling nice and more social at a boring event. Or it could mean death, right. So you can stop breathing. So dosing is really important. That also becomes important when you are kind of working with different experience with alcohol. So if I never drink, I could be technically drunk with after two two cups of something. Right. But someone that's used to it might need eight bottles of beer to really get drunk. So it also depends on how tolerant you are. It depends on the type of environment you're in. If I am smoking marijuana and one of the potential negative side effects of marijuana is paranoia, is it better for me to go and smoke marijuana next to a police precinct or in my house? I'm like fiddling with my friends. Right, right. So a lot of things go into the experience, dose as one of them. How experienced you are with the drug is another one of them. And the environment, of course.

Kirk: Yeah, no, I like the way when I was reading through your papers, I like the way you do differentiate that if you're looking specifically at cannabis, there's nothing there's nothing that we see that affects the cognition of the child. But all the other factors have to be in play where you're living your income, your education, your diet, all the other things that go into healthy, healthy babies. So but if we if we just take the cannabis away, it's not a concern. We can look at other issues. So don't take a baby away because mom says she had a spiff.

Dr. Torres: Well, yeah. I mean, it's kind of we're in a way limited by reality. Right. So the reality is that, of course, the way we do these experiments, it's with real people. Right. That are out there in the world living their lives. And compared to when I was doing experiments in mice where everything, absolutely everything could be controlled and I can really figure out, is this an effect of methamphetamine or not? Because everything was controlled and it's the same kind of concept. Whenever you're doing research with people and searching for these associations between this and that, of course, they can exist. But it's sometimes it's hard to figure out whether something is having a positive effect or a negative effect because people are people, right? We're all so, so, so different. So we have to keep that in mind that that's a limitation of just doing research with people in any case, including cannabis.

Kirk: How many papers would you review?

Dr. Torres: I we started with like fifteen hundred papers and out of this fifteen hundred we had to determine which ones really met the criteria for what we were going for. What do I mean by that. We get fifteen hundred but let's say a thousand of those might not be in people, they might be in mice or rats. So that's not what I was trying to look at. Right. So I have to exclude all of those. And then there were other exclusion criteria, so we end up with forty-five. So that would be the entirety of the of the research on the topic since the late 70s, early 80s.

Kirk: OK, that's and that's, that's the window of the studies was 70s and 80s. There's been those studies recently.

Dr. Torres: Yeah, that's when it started. That's when it started, but we go up until up until now.

Kirk: Yeah, the Jamaican study happened, I think in ninety-four. And then they did a five year, a five year study after that. Do you know if there was any other studies, five years again, 10 years because that studies now music is almost 20, 30 years old. Nineteen ninety-four.

Dr. Torres: Yeah. I'm glad you're asking that because going back to my Jamaican point, another issue is that not only are we doing the majority of the studies with populations in the US and in Canada, but we're also, like I'm saying forty-five studies, but most of the studies come from two studies that started decades ago, and they start looking at the mothers when they're pregnant, then they test the kids at one year old, three years old, seven years old, and they go now, I think now they're like late 20s, 30s. So, it has kind of been all of these studies have mostly been looking at the same kind of people over the last decades. So, it's cohort cohorts that have been studied for four decades, most of them.

Kirk: Interesting, interesting. So, I, I look forward to seeing how your paper applies to clinical studies. I'm involved with lots of cannabis debates and pregnancy and cannabis is always a debate. And everyone always says, well, we know, we know so much. We don't. We assume so much. And I think in medicine it's easier, you know, the whole thing “do no harm,” if we don't know anything, we might as well just say, don't do it.

Dr. Torres: Yeah, yeah, yeah. Which is, you know, it makes sense in a way. Right, because where we're trying to protect in a way. But it does obviously come with this assumption that if we don't know, it might be that there's a negative effect. But what about the equally likely possibility that there might also be a positive one? So, if we don't know, we have to I would love for us to assume equally or give attention to the two possibilities instead of just one.

Kirk: Fantastic. Is there anything else you'd like to say if I. Is there any question I didn't ask that you expected from me?

Dr. Torres: No, not really. I mean, you're the expert at doing questions. I assume, you know, you have done great.

Kirk: Well, I've just also danced around the technology as well.

Dr. Torres: Thank you so much for having me.

Trevor: Kirk. We're back. She is a very, very interesting woman. Know another very smart researcher that I'm always amazed when these smart people agreed to talk to us.

Kirk: Yeah, I agree to it. It's nice. It's nice when they talk to us and we got a good conversation out of it.

Trevor: So, go back to your central theme. Now, what I thought going into this was because as a pharmacist, I get questions about drugs and pregnancy every day, every day, every day. That's a standard question. And my usual answer is, if it's something you can eliminate, do it. You know, if you don't have to use that cough and cold products don't.  If you don't have to. So, and we talk about alcohol and we talk about tobacco a lot, honestly, we don't talk about other drugs much because most people just don't admit they're using any other drugs. But we talk about that a lot. And my standard answer and I think still is if you were a recreational cannabis user. Stop. That's just the safest. But what gets to be more interesting, and I'll get to Dr. Torres in a second, but what would be kind of more interesting is sort of in pharmacy world if you were epileptic, we know some of the epilepsy drugs are harmful to fetuses, but we also know seizures are harmful to fetuses. So, you know, what do you do when an epileptic on one of these drugs gets pregnant? Well, you know, you either do nothing. You try to switch them to possibly less harmful drug. But, you know, there's not the option of stopping because, you know, the disease is not good. We had seizures during pregnancy that's not good for fetuses. So that's clinically more difficult and more interesting. So, I was thinking about what if we have somebody who's using cannabis medicinally and it really is the only thing that's helping them. What do I say then about, you know, I'm pregnant and I'm using it could even be epilepsy. I'm pregnant and I'm using cannabis as part of my epilepsy treatment. What do we do? The answer is I don't know. But it's now more interesting to think about it. Probably it's going to be like every other one is know. Can we possibly eliminate cannabis and some of your other seizure medications before you're pregnant? Maybe if we can't, then, you know, it just might have to be a risk benefit thing with the whole health care team. This but one of the things I also give you the floor back in a second. But one of the things I never considered doing, all of that sort of preamble and listening to it, I just never even occurred to me, what about people who test positive for cannabis and have their kids taken away? Just never even crossed? Never even crossed my mind. And, you know, I think the problem with that policy is, you know, as a pharmacist and you as a nurse and all the health care, you know, we're always a risk versus benefit. So, I think the policy hasn't done that. What is the risk to the child if mom has been using cannabis versus what's the harm if we take the child away? And that was that was fascinating. I never thought about that because obviously taking the child away from mother in many cases is very harmful and probably way more harmful than the cannabis they were using during pregnancy.

Kirk: Well, and that's the key, right? When you raise a very good point. Cannabis has been medicine in Canada for 18 years. Right. So, there are people out to the consume it. Now, when you remove when you remove all other things, if you if you give a lady, a woman, a balanced diet, good exercise, she's got a good education, she's got good living wage coming in. She's got good housing. She has access to primary care practitioners. She has good social supports. She's got a nice warm place and a place to launder her clothing. And she's using cannabis during pregnancy the suggestion is from this interview that we don't need to be fearful as practitioners that the baby is going to be harmed cognitively. Now, now, now, I say that with a lot of caveat because we don't have the studies, but we do. You know, and this is this is what's so interesting. We just interviewed a neuroscientist who just did a study who says that cognitively we can't find any evidence that the child is impaired. So we do have a study that says and supports the fact that if the mother wants to continue continuing using the cannabis.

Trevor: Well, but she was also and it is a good study, but she was also very careful that it was very narrow. Like, for example, she doesn't know that the study doesn't look at what does it do to birth weight, what does there's a bunch of stuff this does not look at. So, again, if you took and still interesting clinically and even becomes non-theoretical if you're the pregnant woman. But it's interesting clinically in so if we because we tell pregnant women and it's not bad things, but I remember Doris was pregnant, a big deal at that point was unpasteurized milk. So, feta cheese was going to and there is it is there is a theoretical risk if you eat feta cheese during pregnancy, some, you know, protozoa is going to attack the fetus like it's a real thing. How likely? I have no idea. It was a tiny risk. But, you know, when you when you're pregnant, it's all about trying to sort of eliminate risk. So, again, back to I don't think I would change my stance of if you are using cannabis recreationally and you got pregnant, should you keep on, you know, if you drink beer recreationally, should you stop? I still I'm still waiting.

Kirk: But we know we know we have we have detailed studies.

Trevor: On alcohol, but I think still on the being safe. Again, if you had a recreational occasional user and she asked me as a pharmacist, should I keep using this? I just like, you know, same thing as she asked me, should I use this cough and cold medication? I'd say no, you know, if you can stop it, go ahead. But I think it's equally as important to go. Well, like she said, you know, I smoked one joint in my second trimester. Well, don't beat yourself up about that.

Kirk: Don't beat yourself up about it.

Trevor: Or I smoke pot all the way through. Should I have my child removed? No, because that appears to be much more harmful. So deep there. There's a lot of nuances here.

Kirk: Exactly. And that's the point of what I'm trying to do with this interview is basically say there's lots of nuances and as practitioners and this is what at the end of the conversation we start talking about policy. Right. And I said up front in the beginning of the episode is that as a nurse in a prenatal program doing prenatal assessments, I have a tick tick, tick, tick, tick, tick, tick. So I am mandated by map. It's a map. Right. And Dr. Torres talks about it if you're mandated by a map, etc… Now, my practices are unique. There's nowhere in my practice that dictates that I have to report a woman that is under the influence of any alcohol or any drug while pregnant. So, I'm not out there reporting people not taking children away. But what I am doing is trying to understand how cannabis relates to my practice. And obviously, cannabis is out there. Nurses, pharmacists, doctors. We're going to confront it. This conversation basically tells us as practitioners that maybe research will eventually catch up to policy. And we don't have to run out and be worried if we isolate cannabis as a mother's consuming cannabis now. Now, having said that, in my research, I have I have stumbled upon some an Australian study. This is an Australian study that I've reached out to the authors, and I'm trying to get them to talk to us. And this study is interesting. Canadian cannabis consumption and patterns of congenital abnormalities and ecological geospatial analysis. This gentleman has basically taken Health Canada statistics and analyzed it and compared it to our Nunavut and Northwest Territories and isolated a potential correlation between cannabis and Down's syndrome and chromosomal abnormalities, congenital abnormalities to people who consume cannabis. So, here's is a discrepancy.

Trevor: I immediately have many, many questions about what he did. But yes, no, if we can get that, that would be. It would be. Yeah. And so there's so many ways that study could be wrong slash Confound slash. But interesting. Interesting.

Kirk: I've read the study. I don't want to raise it here because I want to talk to the authors of it. There's like so what I'm hoping Trevor I'm hoping this is the first of many. To me, prenatal program is a very big part of my practice. And I want to get a lot of people's input on this, but I don't want to do it through fear. And a lot of the stuff that I am given as education for cannabis, and you know, to be honest with you, a lot of it I know that's not true. There's specific education from the Addiction Society of Canada in regards to cannabis. So I want to explore it. So, Trevor, this is one of many I'm hoping that we can find others. You did one of the pharmacy articles. Yeah, I reached out to her, too. Right. So, hopefully she gets back to us.


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