CHAPTER 1
FEEDING THE NEED
The Washington State coastline is a breathtakingly beautiful area of the country. It’s home to the world’s largest population of orcas, which travel thousands of miles from Mexico every year to feed their young in these rich, cold waters. The Salish Sea and the surrounding San Juan Islands are among the top shellfish-producing regions in the nation, with their famous Dungeness crab and geoduck clams. It’s a relatively safe and quiet place to live and work. There’s a reason that business leaders like Bill Gates and Jeff Bezos have snapped up properties here; it’s stunning, peaceful, wild and yet close to one of the biggest cities on the west coast of the United States.
In 2018, however, environmental tests near Seattle revealed something unexpected.
Shellfish, specifically mussels in three locations along the Seattle waterfront and Bremerton shipyard areas, among other areas, tested positive for the prescription painkiller oxycodone, also known as OxyContin and Percocet. In eighteen locations of the eighty tested, mussels also tested positive for detergents, as well as seven kinds of antibiotics, five types of antidepressants, a synthetic insulin commonly prescribed to Type 2 diabetes patients called metformin and a chemotherapy agent called melphalan. Half of the mussels tested positive for iopamidol, which is an X-ray contrast agent that helps in lab technicians’ work.
Mussels situate themselves on rocky outcroppings in the sea bed in the open ocean, but these mussels weren’t wild. The Washington Department of Fish and Wildlife carefully placed these mussels in eighteen Seattle-area locations for the purpose of water testing. Every two years (dependent on funding) state biologist Jennifer Lanksbury and her team transplant mussels from a clean aquaculture source at Whidbey Island to dozens of sites in Puget Sound in order to test the waters, literally. Mussels are unique: they absorb water in a way that allows scientists to accurately gauge the effect of our social practices on animals and our ecosystems, plus the potential for harm to the human body. They’re the new canary in the coal mine for biologists like Lanksbury.
People may be completely unaware of how much all of the pharmaceuticals they are putting into their bodies are affecting their community and making their way into our shared waters: not just in the ocean but also in the rivers and lakes that eventually feed into our drinking water. Yes, wastewater treatment can deal with much of this pharmaceutical excess, but we’re reaching a tipping point at which it becomes increasingly difficult to manage.
“A lot of the pharmaceuticals are probably coming out of our wastewater treatment plants,” Lanksbury says. “They receive the water that comes from our toilets and our houses and our hospitals, and so these drugs, we’re taking them and then we’re excreting them in our urine.”
Mussels, for Lanksbury, are an emblem of where we are heading as a species. The levels of antidepressants that she found in some samples were high enough to be the equivalent of human prescriptions. In other words, it’s as if our sea life is filling prescriptions for several antidepressants, heart medications, insulin and toxic loads of carcinogenic chemotherapy every day.
“It’s become a chemical soup in urban environments,” Lanksbury says. “There’s a cocktail of chemicals out there and it’s an emerging concern. We don’t know how they interact, and they may be multiplying the effects of each other. And it’s not just mussels. We monitor herring, English sole, salmon and orcas on a regular basis. We know that this situation causes cancer in fish, changes in hormones and behavioral changes that limit the ability of these animals to thrive.”
Pharmaceutical overload also affects human beings’ ability to thrive. We want to be well, but we want it to be easy. And that’s why, unlike coastal sea life, we’re taking these drugs willingly, and we’re taking them in larger quantities than ever before.1 We’re eating them up as quickly as we can convince our doctors that we need them.
Eating our pain
By early 2018, it was found that our dependence on the painkillers known as opioids (as they are by-products of the plants used to make opium and heroin) continues to grow at an alarming rate. News reports state that there are nearly 150 opioid-related deaths per day in the United States.2
More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic, according to the latest report from the National Center for Health Statistics, part of the US Centers for Disease Control and Prevention.3 In 2016 alone, 42,249 US drug fatalities—66 percent of the total— involved opioids. That’s over a thousand more than the 41,070 Americans who die from breast cancer every year. Governors are begging Congress to do more to address the issue.4
On a per capita basis, the increase in opioid use over the last three decades has been staggering. We hear about the opioid crisis in America on the news every day, and we assume, wrongly, that it is an issue confined to the streets. In fact, 40 percent of opioid prescriptions are written by general or family practitioners, osteopaths or internists, most commonly for general pain.5 The rest are written by surgeons, prescribed as aftercare for surgeries or other procedures. These are the prescription drugs that we are flooding into our water supplies and even the oceans.
Think about it. The water you drink and the food that you eat are already affected by an over-prescription of opioids, even if you’ve never taken them.
And it’s not just accidental. Studies on unused prescription medications have shown that stimulants, such as Ritalin, and opioids, such as Vicodin and OxyContin, are related to a rise in prescription drug abuse among teenagers.6 In the home environment, there is a greater risk of abuse of these drugs, particularly when adolescents have access to their parents’ unfinished prescriptions. In many cases where teens face significant emotional or psychological challenges, they may turn to prescription drugs to numb the pain associated with their problems even when they don’t have their doctor’s support, and they may also resort to negative behaviors to obtain access to these drugs. For both young people and adults, there is essentially no effort involved in reaching into the medicine cabinet on a regular basis, even when the pills are prescribed to somebody else.
Why are we taking so many drugs?
It’s not just a moral issue. We’re not doing this for fun. Many people assume that taking drugs to the point of overdose is something that only affects the young, that it’s linked to poverty and social disorganization and that it’s a result of poor life choices, but that’s far from the truth. Americans are deeply affected by stress and pain. We comprise 5 percent of the world’s population but consume more than 80 percent of the world’s prescription antidepressants, opioids and amphetamines.7 And if we’re taking it, we’re also drinking it: opioids, blood thinners, hormones, chemotherapy agents and amphetamines are in our water. The increase in the use of these drugs, according to our nation’s own statistics and experts in the field, have contributed to a shortening of the US life expectancy for many years in a row because of the risk of overdose.8 We’re not talking about heroin, but even in their pharmaceutical state, opioids seem to be just as dangerous as street drugs.
And it’s not just physical pain we’re trying to eliminate. Our perceived need for mental health drugs may be warranted. Results from the World Mental Health Survey consortium, which looked at trauma and its effects in twenty-four countries, show that people in the United States experience more subthreshold and deep trauma than almost any country in the world, including those in the Middle East and Africa. In fact, more than 80 percent of our population has seen trauma in our lifetimes.9
What kinds of trauma do we face? Most of what we see is everyday interpersonal violence. This means that when we witness death or serious injury, the unexpected death of a loved one, when we’re mugged or in a life-threatening automobile accident, or experience a life-threatening illness or injury, we feel trauma. These are all examples of subthreshold trauma—in other words, the kind of trauma that adds up over our lifetimes. Deep trauma, such as the experience of a life-altering event like a school shooting or terrorist attack, or our experiences as soldiers on the battlefield, adds to that pain. Over and over again, when we face these events, we also experience psychological revictimization.
The Stress in America survey is conducted online within the United States by Harris Poll on behalf of the American Psychological Association (APA) every year. It tracks how we feel about ourselves, our communities and our future as a nation, and it looks into what stressors affect us the most; it’s been tracking these metrics since 2007. The results of the 2017 survey found that the stress that we face is even more substantial than ever. More than half of Americans (59 percent) said they consider this the lowest point in US history that they can remember—including those who lived through the Second World War and Vietnam, the Cuban Missile Crisis and the September 11 terrorist attacks.10
And this stress doesn’t just affect a few of us; stress reaches across all social divides, from our level of financial security to our race to our level of education and also across political beliefs. “We’re seeing significant stress transcending party lines,” states Arthur C. Evans Jr., PhD, the APA’s chief executive officer. “The uncertainty and unpredictability tied to the future of our nation is affecting the health and well-being of many Americans in a way that feels unique to this period in recent history.”
The most common issues causing stress when thinking about the nation are health care (43 percent), the economy (35 percent), trust in government (32 percent), hate crimes (31 percent) and crime (31 percent), wars/conflicts with other countries (30 percent) and domestic terrorist attacks (30 percent). In other words, we’re perceiving stress from all corners of our lives, from what we experience in our own homes to how safe we think we are from threats in our communities to how we navigate global challenges as a nation.
“With twenty-four-hour news networks and conversations with friends, family and other connections on social media, it’s hard to avoid the constant stream of stress around issues of national concern,” says Evans. “These can range from mild thought-provoking
discussions to outright intense bickering, and over the long term, conflict like this may have an impact on health.”
With this ongoing strain comes a physical response: individual and collective pain brought on by not only recent but centuries of conflict creates a breeding ground for disease in our bodies. We Americans, perhaps more than any other group of people on Earth, have built a nation through the infliction of pain and through enduring conflict. We extracted our freedom from English rule through conflict with European armies and with Indigenous people of this continent. We have created and endured through the pain of slavery and the trade of human lives. We have actively chosen to participate in wars on almost every continent on the globe, and we continue to do so.
Stressed, depressed and diseased
Let me make it simple. The more that we experience stress, the more that we are depressed. The more depressed we are, the more pain our bodies actually feel, and the more susceptible we are to illness and disease.
In essence, when we are depressed, our neurological systems have a heightened response: they send out signals throughout our whole nervous system that tell us to be on high alert. If direct danger doesn’t come, this response doesn’t abate as long as we believe that danger is around the corner. This constant stress response leads to inflammation throughout our bodies, in every cell.
We can think of inflammation as the body’s response to various forms of stress. It can be stress from our environment, such as our diets or excessively loud noises (like living next to a highway). Or it can be self-induced mental stress, such as excessive worrying. When physical or mental stressors are part of our daily life, the body-mind system remains in a state of constant alert—an unintended perception of danger that exists subconsciously and is present in our body as a whole.
Although inflammation has long been known to play a role in allergic diseases like asthma, arthritis and Crohn’s disease, clinicians such as Dr. Tanya Edwards of the Center for Integrative Medicine say that Alzheimer’s disease, cancer, cardiovascular disease, diabetes, high blood pressure, high cholesterol levels and Parkinson’s disease may all be related to chronic inflammation in the body.11 Over time, when the inflammation doesn’t go away, our cells become tired and unable to fight off disease, like fibromyalgia, or they proactively mutate, as in cancer.12
The more that we as a population experience this stress, the more that we will, collectively, become challenged. The more stressed we are, the sicker we get, and the less likely we’ll remain the productive, leadership-oriented Americans that we want to be.
All possible futures
We need to talk about the drugs we are using versus those that we don’t, and why what we’re doing isn’t working anymore.
There is a broad spectrum of medicine that can address stress and almost all of its physical and mental health effects—such as pain, trauma, anxiety, depression—and can even help to alleviate and eliminate some forms of cancer. It calms the central nervous system. It rapidly decreases inflammation and nausea. It makes the pharmaceuticals that we take more effective and less challenging for our nervous systems to process. It has minimal, if any, side effects, and it does not cause intoxication or mental distress. Unlike opioids such as fentanyl or oxycodone or Vicodin, there are zero recorded deaths associated with its use.
It’s called cannabidiol, commonly referred to as CBD. It’s something that we found in cannabis and hemp plants almost 6,000 years ago and learned to use in order to make ourselves well.13
Let’s begin by clarifying some commonly confused terms.
Hemp and marijuana are both forms of cannabis. Cannabis that is rich in tetrahydrocannabinol, or TH C, is marijuana. TH C makes people high. Cannabis with low TH C is called hemp, and it also contains CBD. Both CBD and TH C are health-promoting molecules. Medical products that are made from hemp are not psychoactive, meaning that the level of TH C in the plant is very low. As we’ll explore over the course of this book, however, CBD can make almost anyone’s life better. It is a non-addictive, non-psychoactive plant medicine, which means that it has zero chance of making anyone high.14
Here’s the problem.
CBD has been legally unavailable to Americans because of a bizarre social context in which the possession of marijuana has been perceived as serious of a federal crime as being caught with heroin. In a way, lawmakers have been a bit sloppy. They made all forms of the cannabis plant illegal. Ironically, products such as hemp seed milk are freely sold in stores such as Walmart, but because we can’t grow it here, we import most of the hemp seeds from Canada. We have been denied access to CBD from hemp plants and have subsequently become a nation deeply affected by physical and mental pain, turning to unusually harsh and dangerous pharmaceutical prescriptions. There is an assumption that it, like non-medicinal cannabis, causes more health problems than it solves. But we take opioids every day and, as I’ve shown here, they are killing us. While the legal environment for cannabis is changing both at the state and the federal level, the way we feel about it hasn’t changed all that much.
Ricardo Baca, a former editor at the Denver Post, has specialized in the coverage of cannabis since its entry into the Colorado market after its legalization was passed by voters on November 6, 2012. He explains that CBD is undergoing a shift in the public sphere but is still grossly misunderstood.
“Five years ago people were saying stay away from it,” Baca says. “Today, the Food and Drug Administration has approved it as medicine. We’re re-scheduling it. But even cocaine is a Schedule 2 drug. Cannabis, including CBD, has been a Schedule 1 drug for almost one hundred years.”
Schedule 1 drugs are, in the words of the Drug Enforcement Agency, the “most harmful” substances to the American public. As Baca explains, CBD, a product of a non-psychoactive plant with no side effects and no associated deaths, has been listed as more dangerous than cocaine, despite the fact that cocaine is responsible for the largest increase in overdose deaths, at least among street drugs, for the last five years running.15
Because it’s been largely unavailable to prescribe for years, CBD is not widely known or trusted by doctors or by the general public as a wellness tool. To most Americans, cannabis medicines seem like snake oil or a hippie drug. But that’s not the case according to most researchers. As we’ll explore here, the discovery of the endocannabinoid system in the body has produced more than 10,000 new evidence-based research studies over the last thirty years on CBD and its effects on human and animal health.
The results are unequivocal: researchers have tested CBD as a possible treatment and even a cure for conditions as diverse as sleep apnea, cardiovascular disease, epilepsy, chronic neuropathic pain, Alzheimer’s disease, Parkinson’s disease and so many more.
The question of self-care
There is absolutely no question, from the point of view of Western medical research, that CBD is the real deal. Don’t get me wrong: it may not be a cure for every ailment on the planet. CBD may lead us on the path forward, the healthy path, that we’ve been seeking all of our lives. And, in some cases, it may not. Even so, CBD is probably the closest thing we’ve found to a magic solution for health in the history of our species, as most of the researchers, medical practitioners and patients I’ve met in the course of my own CBD journey have told me. It’s worth exploring how we can use this plant medicine to improve our lives.
And CBD isn’t the only plant medicine we’re underusing. While I want to explore CBD in particular, as someone whose past career was dependent on understanding how we can best care for our bodies and our minds, I’ve come to learn that there are a lot of extremely powerful medical traditions that Americans at best ignore and at worst demonize. We have been lacking the initiative to do anything but follow the status quo for so long that we’re out of practice in helping ourselves. We need to create pathways to wellness that work for each of us, and that requires new information, a commitment to self-care and the freedom to choose what is right for our individual health.
We’re nonetheless left with a number of questions. Why are we afraid of trying a plant medicine that is made from cannabis? Why do we ignore plant medicines altogether? Why are we stuck in this stress loop, inching our way toward permanent debilitation and disability? Why do we keep feeding ourselves deeply dangerous pharmaceuticals, rather than addressing the underlying problems that we face as individuals and as a nation? How can we shift toward wellness and build new and more effective medical habits within our health care system?
Part of the challenge is the health care system itself.
Despite the fact that the US health care system is the most comprehensive in the world, it is also the costliest.16 The cost of American health care is prohibitive on a national level compared to nations with public health systems. According to the Organisation for Economic Co-operation and Development (OE CD), the cost of health care to the US public consisted of 16 percent of GDP, even though the majority of health care is private and US government programs only cover 27.8 percent of the population’s overall health care needs. It is the second-highest percentage rate of health care costs among all OE CD nations. In Canada, where the entire health care system is public and covers 100 percent of the population’s fundamental health care needs, the cost of provision was less than 10 percent of gross domestic product (GDP) in the same year. In the UK, it was just over 8 percent for a fully public system.17 The World Health Organization (WHO) has ranked the US health care system first in responsiveness but thirty-seventh in overall performance and seventy-second by overall level of health (among 191 nations).18 The United States ranks poorly in terms of years of potential life lost (YPLL), a statistical measure that predicts being saved by health care. Among OE CD nations, the United States ranked third to last for the health care of women and fifth to last for men. On top of this, survival from major illnesses in the US is systematically and substantially lower for those living in poverty.19
The high rate of underinsured Americans, especially given all of the continued debate over federal health care policy, is an economic burden to the nation and morally questionable as we let those without the means suffer and die from preventable illnesses.
What this means is that our emerging concern isn’t the mussels or even the opioids and antidepressants in our waters. We can make changes to clean our water systems and shift the environmental status quo, and we can change our policies. As Lanksbury points out, however, our actual emerging concern is our health habits. As Americans, we have a responsibility to the planet, but we also have a responsibility to our own health and happiness. Like our record with the environment, however, we may very well be on track to destroy the collective well-being and safety nets that we’ve created, because we think in terms of quick fixes rather than preventative care.
We’re not looking critically at what we eat, how we live and how we care for ourselves and each other. We are, in fact, a nation in deep pain and distress. But we can change this, and change our collective future.
It’s my goal in this book to investigate the links between our health and our choices and how Americans can find a better way forward to wellness. I’ll show you just how profound our collective endocannabinoid deficiency really is and its effect on our health care, our stress levels, our disease burden and our future.
1. [National Institute on Drug Abuse. (2017). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/ overdose-death-rates]↩
2. [Kounang, N. (2017, December 21). Opioids now kill more people than breast cancer. CNN. Retrieved from https://www.cnn.com/2017/12/21/health/drug- overdoses-2016-final-numbers/index.html]↩
3. [National Institute on Drug Abuse. (2017).]↩
4. [Mulvihill, H. (2018). Governors to Trump, Congress: do more to solve opioid crisis. KMTR. Retrieved from http://nbc16.com/news/nation-world/governors-to-trump-congress-do-more-to-solve-opioid-crisis-01-18-2018]↩
5. [Okie, S. (2010). A flood of opioids, a rising tide of deaths. New England Journal of Medicine, 363(21), 1981–1985.]↩
6. [Alemagno, S.A., Stephens, P., Shaffer-King, P., & Teasdale, B. (2009). Prescription drug abuse among adolescent arrestees: correlates and implications. Journal of Correctional Health Care, 15(1), 35.]↩
7. [Manchikanti, L. (2007). National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician, 10(3), 399.]↩
8. [National Institute on Drug Abuse. (2017). Overdose death rates.]↩
9. [Benjet, C., Bromet, E., Karam, E.G., Kessler, R.C., McLaughlin, K.A., Ruscio, A.M. , . . . & Alonso, J. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327–343.]↩
10. [American Psychiatric Association (2018). Lowest point. Retrieved from http://www.apa.org/news/press/releases/2 0 1 7/1 1 /lowest-point.aspx]↩
11. [Edwards, T. (2005). Inflammation, pain, and chronic disease: an integrative approach to treatment and prevention. Alternative Therapies in Health and Medicine, 11(6), 20.]↩
12. [Egeland, M., Zunszain, P.A. & Pariante, C.M. (2015). Molecular mechanisms in the regulation of adult neurogenesis during stress. Nature Reviews Neuroscience, 16(4), 189.]↩
13. [Wattie, C. (2018, June 21). Here’s the 6,000 year history of medical marijuana. Business Insider. Retrieved from http://www.businessinsider.com/ heres-the-6000-year-history-of-medical-marijuana-2018-6]↩
14. [Iffland, K., & Grotenhermen, F. (2017). An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis and Cannabinoid Research, 2(1), 139–154.]↩
15. [Centers for Disease Control. (2018). Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm]↩
16. [Anderson, G., Reinhardt, U., Hussey, P., & Petrosyan, V. (2008). It’s the prices, stupid: why the United States is so different from other countries. Health Affairs, 22(3), 89–105.]↩
17. [OECD. (2018). OECD Health Data—Frequently Requested Data. Retrieved from http://www.oecd.org/document/16/0,3343,en_2649_33929_2085200_1_1_1_1,00.html]↩
18. [World Health Organization. (2018). World Health Organization assesses the world’s health systems. Retrieved from http://www.photius.com/rankings/who_ world_health_ranks.html]↩
19. [Sack, K. (2008, April 27). The short end of the longer life. The New York Times. Retrieved from http://www.nytimes.com/2008/04/27/weekinreview/27sack. html?_r=1]↩