Scromiting

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Just when you thought throwing up
couldn't get worse.

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This symptom is sending people

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to the emergency room
screaming, crying, gagging and vomiting.

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Now, when all of these issues
collide, it's called screaming.

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And you'll never guess what causes
that symptom.

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I might.

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I might have.

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Welcome to on call off
Script, the Jackson Health System podcast.

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Our expert is Doctor Jeffrey Bernstein.

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He's the medical director of Miami

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Poison Control Center
at Jackson Memorial Medical Center now.

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Doctor Bernstein,
let's get the big question out of the way.

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What causes prompting?

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What is it?

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Well, scrummaging is a fun term.

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Yeah, it's a fun term.

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You know, in the emergency department,
we see so many horrible things

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all the time that we've developed
what we call a gallows sense of humor.

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Yeah. So we have to kind of find light
where, where we can.

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But really, it's a it's a serious problem.

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We don't like to make light of it.

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It's very,
very uncomfortable for the patient.

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And it occurs in chronic
heavy users of marijuana.

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And what I understand is it's called
cannabinoid hyperemesis syndrome.

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What does that mean.

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Cannabinoid hyperemesis syndrome.

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So while we use cannabinoids marijuana

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marijuana contains

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really hundreds of different chemicals
called cannabinoids.

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So there's a bunch of different
cannabinoids.

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It's not just one thing.

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And while we use it to stop people
from vomiting

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for chemotherapy, for example, or people

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that have other,

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you know, chronic conditions
that would cause them to vomit.

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We use them.

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We use cannabinoids
to stop them from vomiting.

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But there are some people

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that just hits the receptors wrong
and their body turns against it.

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And it just causes them to vomit.

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From another episode that we recorded
with Doctor Tan, he explained

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that your stomach paralyzes and
and that's what causes.

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So is it really
is a sort of poisoning of cannabis?

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Well, it's,

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you know,
it's the receptor in your brain that that,

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causes you to vomit.

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It also causes you not to vomit
if you bind it up the right way.

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But, you know, it's a lot like,

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you could eat strawberries
your entire life,

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and then one day you become allergic
to strawberries.

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Your body just doesn't
tolerate strawberries anymore.

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And so it's kind of analogous to that.
Right.

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And I can imagine over time,
has this always been a thing?

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Has does
the use of marijuana changed over time?

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Have you seen that that difference?

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Well, it has cannabinoid hyperemesis

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syndrome was first diagnosed in 2004.

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But over the past two decades, marijuana

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use has increased,
marijuana use has increased,

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and the potency of marijuana
has really increased from the 70s.

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Back in 1970, a marijuana cigaret
or a joint

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contained about ten milligrams of THC

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tetrahydrocannabinol, which is the active
and psychoactive form of marijuana.

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Today, a

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marijuana cigaret would have about 150mg.

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So it's become a lot more potent
and a lot more

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people are using it,
and we have a lot more forms of it.

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Used to be what we call leaf marijuana,

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where people would roll a joint
and then smoke it.

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Now we have oils and edibles,

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waxes and gummies and,

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you know, even Dorito chips
that have marijuana in,

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we have vape pens.

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We of course still have leaf.

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We have, different tinctures
now, and it's really difficult

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to know what the potency
of each of those products are.

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And you know what you're getting.

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And that's when things can get tricky of
of possibly overdosing yourself.

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Is is that a possibility with cannabis?

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It's definitely a possibility. You know.

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The problem is well, okay.

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Well, let's go back a little bit.

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In 2018,
we passed something called the farm Law.

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And the farm law allowed farmers
to grow hemp

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or clothing and, you know, other products
that you would use a rope.

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Exactly.

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And the law stated that

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as long as the product has less than 0.3%

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delta nine THC, which is the main,

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you know, active component of marijuana,
then it was legal to sell.

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Well, they didn't say anything about delta
eight THC or Delta

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ten THC and, you know, you see the like.

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Yep. And well,
because they're they're technically legal.

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And so

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UK as long as it has
less than a certain percent.

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So that allows two things.

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One, if you make it
a really heavy product,

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if you make it a cookie
that's kind of wet and very heavy,

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you can put a lot of Delta nine in there
and basically be selling legal marijuana.

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And it could also have Delta

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eight or Delta 10
or 1 of these other cannabinoids.

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That's not delta nine THC.

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And there's no law against that. Right.

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There's like
and you can have a combination of those.

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So it's really tough to know

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when you're buying the product,
even if it says how many milligrams

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of delta nine.

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Well, you know, how many total
psychoactive cannabinoids are in there.

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And it doesn't sound like there's
a lot of regulation. Right.

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So you can have a mixture of anything.

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And then when it comes to scrummaging,
does it really make a difference

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if you're ingesting it rather
than smoking it rather than a wax form?

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No, it really doesn't.

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And although this disease

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occurs in, chronic

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heavy users and they say, you know,
that the incidence of use has gone up.

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It's almost doubled in the past
two decades.

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So right now, you know, they say about

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16% of the US,

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admits to having used marijuana
in the past month.

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Now those are people that admit to it.

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Yeah. Right.

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So we know we know there's
probably a lot more than that.

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And if you are and among those people.

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Right.

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21 days or more, the average

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person has used marijuana
more than 21 days in the past month.

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Oh, so that would you
you would define that as overuse. So.

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Well, you know, it's heavy.

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It's hard to it's
I would decline that is heavy use right.

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If you're using it every day
then then that's pretty heavy use.

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Right.

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And they say that up to 30%

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of chronic users of marijuana
will eventually develop this syndrome.

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Well 30% about a third of people will,
you know, that use it heavily will use it.

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So we understand that scrambling is
I don't want to say an extreme end,

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but at least a chronic end.

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I want to switch the conversation
over to what

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we've seen in recent news of teenagers,
right, with with marijuana edibles

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or who knows what's in these gummies
and cookies

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that people come to school with
and then end up having medical episodes,

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whether that is, panic attack to anything
from something physical.

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Have you seen an increase in those cases
and how are those handled?

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We we have seen
an increase in those cases.

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You know, the overwhelming majority

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of people that use marijuana don't end up
in the emergency department, right?

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Okay. So we have different age groups.

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You know, we have the toddler
that gets into their parents.

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Gummy. Yeah.

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And, or their parents edible product and,
you know, but they look like gummy bears.

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Yeah. So they look like candy, right?

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And there are a lot of products out there
that are made to look like candy.

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They're made to look like cookies, Dorito
chips, Oreos,

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you know, and even though they say,

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you know, Stoney O's or they say creative
or they have some creative marketing

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based name, yeah, they still look like,
you know, if you're a toddler,

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you're not reading that name.
You're just seeing the picture.

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And you know what? Those are.

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And so you're
it makes it very enticing to actually,

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you know, a child
to be able to get into it.

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And the dosing,
of course, is not meant for children.

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If I look back in

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my database about seven years ago,
I think I,

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we had about six cases of toddlers,

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getting into, you know, edible products.

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Last year,
I think we topped about 800 cases.

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That's incredible.

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So it's. Yeah, it's a huge number. Yeah.

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It's just that much more accessible
to people and a huge problem at that.

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I mean, I can't even imagine being
a parent and bringing my toddler in. And

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how do you explain that to your physicians
who are trying to write help you?

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Well, well, this is
this is another one of the problem, right.

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As far as scrummaging goes, you know,
with with abdominal pain, with vomiting

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and abdominal pain from cannabinoid
hyperemesis syndrome, the average patient

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or at least not not so much anymore,
but at least one, you know, for the past

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two decades or so,
the average patient goes to the emergency

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room seven times
before they're actually diagnosed. Wow.

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Now it's become common enough
that emergency physicians are very

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they an they they know.

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They know what it is.

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They hear somebody screaming
in the next room, and they have an idea

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that that that might be
in your differential diagnosis.

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Yeah. It's
but that's when you get the call I'm sure.

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Right.

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So I know we talked about toddlers,
but when we get to that teenage age right.

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That's that's your,
your era of exploration, I can imagine.

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Right.

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How do parents or even teenagers
navigate their own, either

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scrambling situation
or just exposure to marijuana in general?

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Well, we I mean,
we have a few treatments for it.

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You know, the patient comes in,

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and among the teenage population

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that represents about,
I think, about 16% or

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so of our, of the, you know, the range
of people that use marijuana.

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They tend not to be like the

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heaviest users, believe it or not, it's
usually an older, older age group.

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You would think that it's all teenagers
experimenting, trying to get it.

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That's my first assumption.

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And interestingly, overall

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marijuana as of 2022 has passed alcohol

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in terms of use, except in teenagers
where it's still alcohol,

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but it's put it's pretty neck and neck,
it's pretty neck and neck.

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And it also,
you know, our statistics also depend

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on, people admitting that they,
that they did marijuana, right.

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I mean, the the high profile cases we've
seen on the news are high profile, right?

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I can imagine what we've seen is like
it'll be a group of kids

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and they all start to feel sick after
something was passed around at school

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and handed out.

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Right.

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Well,
especially if you're a first time user

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and you know, somebody gives you
what you think is a gummy bear,

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and the next thing you know,
you're you're high up in school

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in front of adults in front, right?

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You know,

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and you're not used to it, you know, that
that creates a certain amount of panic.

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And yeah, you know, while marijuana
for the most part is relatively safe,

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other than very small children,

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you know, we don't have a lot of deaths,
but it does.

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It does cause a lot of morbidity.

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You know,
people end up in the emergency department

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and you know that
that's pretty uncomfortable, right?

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So talking about poison control
as a whole, what we understand

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is that your center covers six counties.

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And I can imagine that's a tall task.
Yeah.

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So we are the poison control center
for palm, Broward, Dade, Monroe

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Lee and Collier County.

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So it's so it's all six counties. Yeah.

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We get callers from homes,
we get callers from hospitals.

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We we are consultants to other physicians.

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But anybody can call.

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We have an 800 number 1-800-222-1222.

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That's a, a national number
run by herself.

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And, depending on the area
code of your phone,

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you get routed to the nearest poison
control center.

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Now, over the years, I can imagine
that you've been able to collect

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tons of data on what's going on,
especially about South Florida culture.

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Are there any things that are uniquely
Miami or uniquely South Florida that

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your other jurisdictions,
your peers, are just not going to see?

239
00:12:27,646 --> 00:12:30,049
We have a few
things that are that are uniquely Miami.

240
00:12:30,049 --> 00:12:32,451
I mean, this weekend, you know,

241
00:12:32,451 --> 00:12:37,907
you know, the northeast is notorious
for getting all the carbon monoxide cases.

242
00:12:38,457 --> 00:12:40,109
Right now we're having a cold snap.

243
00:12:40,109 --> 00:12:43,829
It was as low as, I think, 35 degrees
yesterday here in Miami.

244
00:12:43,829 --> 00:12:47,249
And we had four carbon
monoxide cases over the weekend.

245
00:12:47,566 --> 00:12:51,837
So, even though things are regional,
you do see things,

246
00:12:53,005 --> 00:12:54,657
you know, out, out of place.

247
00:12:54,657 --> 00:12:58,761
And who would have thought of a quick cold
freeze would have potentially

248
00:12:58,761 --> 00:13:02,148
poison people in there and, well, people
people are running generators.

249
00:13:02,448 --> 00:13:05,417
When the power goes out in their home,
people bring in space

250
00:13:05,417 --> 00:13:08,420
heaters, particularly gas powered space
heaters.

251
00:13:08,487 --> 00:13:11,874
People bring their barbecue grill
into the garage.

252
00:13:12,441 --> 00:13:16,679
People, you know, sit in their car
and run the heat to, you know, for warmth.

253
00:13:16,679 --> 00:13:21,083
And so, you know, in Miami,
we're just not prepared for cold.

254
00:13:21,200 --> 00:13:21,717
Yeah.

255
00:13:21,717 --> 00:13:23,068
We're we're okay. We are.

256
00:13:23,068 --> 00:13:25,221
Most of us have air conditioners, right?

257
00:13:25,221 --> 00:13:28,073
But but, you know,
very few people actually have heaters.

258
00:13:28,073 --> 00:13:30,926
Yeah. Miami. Or at least,
you know, we don't run them anyway.

259
00:13:30,926 --> 00:13:32,761
Anything else that's uniquely Miami there.

260
00:13:32,761 --> 00:13:33,646
There are a lot of alcohol

261
00:13:33,646 --> 00:13:37,516
poisoning cases or or high drug use
that you guys deal with.

262
00:13:37,516 --> 00:13:39,752
We really run the gamut here in Miami.

263
00:13:39,752 --> 00:13:43,823
We have, you know,
we have occupational medicine.

264
00:13:44,607 --> 00:13:48,143
We see, some lead, mercury, arsenic.

265
00:13:48,327 --> 00:13:51,780
We run our poison center runs the marine

266
00:13:51,780 --> 00:13:55,584
toxin hotline
so that we see jellyfish stings.

267
00:13:56,368 --> 00:13:58,888
Lionfish. Lionfish.

268
00:13:58,888 --> 00:14:01,907
Although most of our lionfish
calls are actually home aquarium.

269
00:14:02,191 --> 00:14:03,142
Really? Yeah.

270
00:14:03,142 --> 00:14:03,809
Very few.

271
00:14:03,809 --> 00:14:04,159
We do.

272
00:14:04,159 --> 00:14:07,162
We do get stings for people
that are diving.

273
00:14:07,279 --> 00:14:07,580
Really?

274
00:14:07,580 --> 00:14:10,583
Most of them are home aquariums.

275
00:14:10,583 --> 00:14:13,485
They're cleaning the aquarium.
They're changing the coral.

276
00:14:13,485 --> 00:14:16,488
We get cases of zoo. Aren't coral?

277
00:14:16,488 --> 00:14:20,025
Actually,
live coral has a toxin called poly toxin.

278
00:14:20,276 --> 00:14:23,846
And people will be cleaning their tank,
changing the coral,

279
00:14:24,079 --> 00:14:26,782
moving it around,
and then maybe they rub their eye

280
00:14:26,782 --> 00:14:28,918
where they pour hot water
into the aquarium,

281
00:14:28,918 --> 00:14:33,205
and then they inhale the toxin
as it's released into the atmosphere.

282
00:14:33,239 --> 00:14:33,906
Interesting.

283
00:14:33,906 --> 00:14:38,711
And what happens to your body,
then, is 80%, not not so much higher.

284
00:14:38,711 --> 00:14:39,328
Okay.

285
00:14:39,328 --> 00:14:42,031
But but difficulty
breathing and bronchospasm.

286
00:14:42,031 --> 00:14:43,916
Yeah. Wheezing and,

287
00:14:45,150 --> 00:14:46,702
you know, respiratory difficulties.

288
00:14:46,702 --> 00:14:49,371
Well, that's a scary and a lot of eye pain
if you rub your eyes.

289
00:14:49,371 --> 00:14:53,392
I mean, I can imagine we have people
that step on stingrays here.

290
00:14:53,392 --> 00:14:56,395
Yeah, we have the Portuguese man of war.

291
00:14:56,478 --> 00:14:58,280
I've seen those bottles on the beach.

292
00:14:58,280 --> 00:15:00,299
Plastic bags on the beach. Exactly.

293
00:15:00,299 --> 00:15:02,635
They look like blue bottles.

294
00:15:02,635 --> 00:15:04,787
Called blue bottle sometimes. Yeah.

295
00:15:04,787 --> 00:15:06,472
And you have to be really careful.

296
00:15:06,472 --> 00:15:09,925
They they are notorious for having very,
very long tentacles.

297
00:15:10,609 --> 00:15:14,096
So much so that people can get wrapped up
in the tentacles.

298
00:15:14,096 --> 00:15:18,050
And so very large body
surface area stings.

299
00:15:18,050 --> 00:15:18,417
Are those

300
00:15:18,417 --> 00:15:22,037
some of the worst cases that you see when,
when you're consulting with patients?

301
00:15:22,755 --> 00:15:23,606
I wouldn't say that.

302
00:15:23,606 --> 00:15:25,457
They're the worst cases,

303
00:15:25,457 --> 00:15:27,960
but they're, you know,
but they're but they're very painful.

304
00:15:27,960 --> 00:15:31,013
And particularly if you have a young child
that gets wrapped up

305
00:15:31,013 --> 00:15:34,016
in the tentacles,
it's a it's a large body surface area.

306
00:15:34,316 --> 00:15:37,553
And that can be potentially, disastrous.

307
00:15:37,553 --> 00:15:39,888
We also have, various,

308
00:15:41,190 --> 00:15:44,426
fish poisonings, food poisonings
that occur from eating fish.

309
00:15:45,077 --> 00:15:48,931
There's one called scam roid,
which is histamine fish poisoning.

310
00:15:48,931 --> 00:15:54,320
So it's so fish
that isn't properly, frozen or cold.

311
00:15:54,320 --> 00:15:56,839
So we're talking about our sashimi,
our nigiri,

312
00:15:56,839 --> 00:15:59,241
that kind of those kinds of poisonings.
Not so much.

313
00:15:59,241 --> 00:16:00,626
You know, most sushi restaurants

314
00:16:00,626 --> 00:16:04,313
know how to prepare fish, but people
that go out and catch fish fresh,

315
00:16:04,496 --> 00:16:07,066
and they don't put it on ice right away.

316
00:16:07,066 --> 00:16:09,952
Bacteria in the flesh of the fish convert

317
00:16:09,952 --> 00:16:12,955
the amino acid histidine to histamine.

318
00:16:13,022 --> 00:16:16,141
So it's a histamine poisoning,
just like the histamine that gets released

319
00:16:16,342 --> 00:16:18,027
in your allergic reactions.

320
00:16:18,027 --> 00:16:20,479
Oh man. There's painful though.

321
00:16:20,479 --> 00:16:24,500
There's another one, called sig terror
that,

322
00:16:25,167 --> 00:16:28,170
occurs in reef fish.

323
00:16:28,771 --> 00:16:31,306
In kind of the Caribbean where we are, it

324
00:16:31,306 --> 00:16:34,426
also occurs in the Indian Ocean
and now by Hawaii.

325
00:16:34,643 --> 00:16:38,630
And, fish
that live on the coral reefs eat,

326
00:16:40,049 --> 00:16:41,667
algae that live on the coral reef.

327
00:16:41,667 --> 00:16:43,318
And they developed something called sig.

328
00:16:43,318 --> 00:16:45,137
Tara. Okay.

329
00:16:45,137 --> 00:16:48,924
So it starts as gastroenteritis,
nausea, vomiting.

330
00:16:48,924 --> 00:16:51,827
And then you develop neurologic symptoms.

331
00:16:51,827 --> 00:16:53,328
And the most notorious

332
00:16:53,328 --> 00:16:57,166
of which the most we call path
mnemonic is hot cold reversal.

333
00:16:57,166 --> 00:16:59,835
So, so it's it's the cold sweat.

334
00:16:59,835 --> 00:17:01,520
So no, not the cold sweats.

335
00:17:01,520 --> 00:17:02,304
It's that cold.

336
00:17:02,304 --> 00:17:05,307
Things feel hot and hot things feel cold.

337
00:17:05,340 --> 00:17:08,293
So you know how if you lay on your hand
and your hand falls asleep,

338
00:17:08,293 --> 00:17:09,411
it gets tingley.

339
00:17:09,411 --> 00:17:10,579
So it's like that.

340
00:17:10,579 --> 00:17:13,248
So they they feel that hot cold reversal.

341
00:17:13,248 --> 00:17:15,267
They feel like there are teeth are loose.

342
00:17:15,267 --> 00:17:18,404
They get ringing in their ears,
they get a metallic taste in their mouth.

343
00:17:18,587 --> 00:17:22,641
And the worst part is
it can last for for several weeks, months,

344
00:17:22,641 --> 00:17:24,176
even up to about two years.

345
00:17:24,176 --> 00:17:26,161
I was going to ask,
how do you treat something like that?

346
00:17:26,161 --> 00:17:29,148
Because it sounds like your whole body
just goes out of whack.

347
00:17:29,431 --> 00:17:32,067
It's pretty, it's
pretty miserable for those patients.

348
00:17:32,067 --> 00:17:35,070
And we do have medicines
that we can use to treat them.

349
00:17:35,521 --> 00:17:36,889
But there really is no cure.

350
00:17:36,889 --> 00:17:40,342
It's really symptomatic and supportive
care until they get over it.

351
00:17:40,342 --> 00:17:41,510
So it sounds like a good chunk

352
00:17:41,510 --> 00:17:45,631
of what you guys do
besides helping patients is education,

353
00:17:45,631 --> 00:17:48,617
because what are you going to do
if you know better, you can do better.

354
00:17:48,617 --> 00:17:51,420
But we have educators
working for the poison Center.

355
00:17:51,420 --> 00:17:56,425
We, we keep, statistics about where
we're getting calls from, about where,

356
00:17:57,626 --> 00:17:58,193
where we're

357
00:17:58,193 --> 00:18:01,196
getting, for example, red tide calls.

358
00:18:01,230 --> 00:18:04,216
So in certain warm weather, weather,

359
00:18:05,300 --> 00:18:09,538
algae flourishes, harmful algal blooms,
we call them flourish.

360
00:18:09,538 --> 00:18:13,108
And we can actually tell
the Department of Health

361
00:18:13,292 --> 00:18:16,612
where the algal blooms are based on
where our calls are coming from.

362
00:18:16,862 --> 00:18:20,883
Oh, so it's just more than just
being out on the edge and seeing it come.

363
00:18:20,899 --> 00:18:22,968
It's a certain amount of surveillance.

364
00:18:22,968 --> 00:18:26,121
Yeah, it's a certain amount
of surveillance that we do.

365
00:18:26,121 --> 00:18:31,460
So we have all of our data is uploaded,
uploaded, uploaded your file,

366
00:18:31,910 --> 00:18:36,448
all of our data
is uploaded to a, a data center.

367
00:18:36,482 --> 00:18:37,216
Yeah.

368
00:18:37,216 --> 00:18:39,918
And that data is mined both,

369
00:18:39,918 --> 00:18:43,238
gear in by the Florida Department
of Health and nationally.

370
00:18:43,422 --> 00:18:47,759
And so they know
how many of each type of poison,

371
00:18:47,759 --> 00:18:50,762
how many cases we get per day, per week,
per month.

372
00:18:50,762 --> 00:18:55,751
And so if we go over
a certain, number of cases,

373
00:18:56,051 --> 00:18:59,771
then you know that they will call me
and say, hey, what's going on in Miami?

374
00:19:00,005 --> 00:19:01,840
And so we'll investigate it.

375
00:19:01,840 --> 00:19:02,591
That's interesting.

376
00:19:02,591 --> 00:19:05,594
So a third of it is research, right?

377
00:19:05,611 --> 00:19:07,212
A third of it is education.

378
00:19:07,212 --> 00:19:08,747
A third of it is helping patients.

379
00:19:08,747 --> 00:19:11,316
That's a probably profound. Yeah.

380
00:19:11,316 --> 00:19:14,369
And and a lot of it is over the phone.

381
00:19:15,487 --> 00:19:17,472
You know, we know you know, we're

382
00:19:17,472 --> 00:19:20,759
not in the business of taking any chances,
but we do know who can stay at home.

383
00:19:20,943 --> 00:19:21,193
Yeah.

384
00:19:21,193 --> 00:19:26,415
So if you call the 800 number and,
you've taken something that we know

385
00:19:26,415 --> 00:19:30,252
is not going to be a problem for you,
we can manage you at home.

386
00:19:30,252 --> 00:19:32,855
We do a follow up call,
we make sure they're okay.

387
00:19:32,855 --> 00:19:36,341
And so that saves you
from having to call 911. It

388
00:19:36,341 --> 00:19:40,179
saves you from having to go unnecessarily
into the emergency department.

389
00:19:40,262 --> 00:19:40,479
Right.

390
00:19:40,479 --> 00:19:46,151
It saves you from, you know, expensive,
medical medical tests and fees.

391
00:19:46,151 --> 00:19:51,340
And so, we estimate that we save about $17

392
00:19:51,907 --> 00:19:56,228
for the community for every dollar
spent on running poison control.

393
00:19:56,228 --> 00:19:57,179
So that's incredible.

394
00:19:57,179 --> 00:20:01,200
So your team is educated enough
to even say to you do need to call 911.

395
00:20:01,200 --> 00:20:02,684
You need to go into the hospital. Yes.

396
00:20:02,684 --> 00:20:04,836
So and we work together with 911.

397
00:20:04,836 --> 00:20:08,774
So, so if you call 911
and it's a poisoning,

398
00:20:08,891 --> 00:20:10,592
they will patch us together

399
00:20:10,592 --> 00:20:13,212
with the patient
and we can determine whether the patient

400
00:20:13,212 --> 00:20:16,832
needs to be transported or
whether they can be safely left at home.

401
00:20:17,149 --> 00:20:17,833
That's really great.

402
00:20:17,833 --> 00:20:22,421
So circling us back all the way back
around to scrummaging and substance use,

403
00:20:23,805 --> 00:20:25,724
how do we educate the public about that?

404
00:20:25,724 --> 00:20:26,024
Right.

405
00:20:26,024 --> 00:20:29,011
Because I think half of it is,

406
00:20:30,128 --> 00:20:32,731
do you guys go out and say
marijuana is wrong

407
00:20:32,731 --> 00:20:36,752
and that don't smoke marijuana,
or is it more about moderation

408
00:20:36,885 --> 00:20:40,122
if you are, it's a lot about moderation.

409
00:20:40,122 --> 00:20:42,190
I mean, we don't, you know,
we don't make the laws.

410
00:20:42,190 --> 00:20:42,991
Of course we don't.

411
00:20:42,991 --> 00:20:46,712
And, you know, our
our calls are all confidential.

412
00:20:46,862 --> 00:20:47,579
Okay.

413
00:20:47,579 --> 00:20:49,331
We don't share any information,

414
00:20:49,331 --> 00:20:52,334
any personal information
or any identifying information.

415
00:20:52,501 --> 00:20:53,652
So you can call us.

416
00:20:53,652 --> 00:20:55,871
You can give us your name,
your phone number.

417
00:20:55,871 --> 00:20:57,973
We're not going to share that
with anybody.

418
00:20:57,973 --> 00:21:00,959
And so and so we we don't judge.

419
00:21:01,026 --> 00:21:03,729
Right. And

420
00:21:03,729 --> 00:21:06,999
so yeah, it's a lot about education.

421
00:21:06,999 --> 00:21:07,683
Yeah.

422
00:21:07,683 --> 00:21:11,570
The problem with cannabinoid hyperemesis
syndrome is denial.

423
00:21:12,404 --> 00:21:14,473
Yeah. You know, a lot of people,
they don't want to believe it.

424
00:21:14,473 --> 00:21:16,925
Here, I'll tell you a story,
a personal story.

425
00:21:16,925 --> 00:21:19,294
A friend of my wife and I,

426
00:21:20,762 --> 00:21:22,381
was was

427
00:21:22,381 --> 00:21:26,018
having abdominal pain and vomiting
and going to the emergency department.

428
00:21:26,618 --> 00:21:29,705
She ended up going twice,
and my wife told me about,

429
00:21:29,738 --> 00:21:31,506
you know, her story and said, yeah.

430
00:21:31,506 --> 00:21:36,194
And I said, you know, this sounds a lot
like cannabinoid hyperemesis syndrome.

431
00:21:36,611 --> 00:21:40,148
And so my wife turned around
and told her about it.

432
00:21:40,148 --> 00:21:43,485
And she said, no,
no, I'm, I'm not really smoking,

433
00:21:44,586 --> 00:21:45,304
that much.

434
00:21:45,304 --> 00:21:47,789
And, I don't think that's
what it could be.

435
00:21:47,789 --> 00:21:52,627
And then about six months later, my wife
said, you know, she still, you know,

436
00:21:52,627 --> 00:21:54,162
they can't figure out
what's wrong with her.

437
00:21:54,162 --> 00:21:56,348
She keeps going to the emergency
department

438
00:21:56,348 --> 00:21:59,851
and, you know, they
they can't figure it out.

439
00:21:59,851 --> 00:22:03,338
And I said, you know, this really
sounds like cannabinoid hyperemesis it.

440
00:22:03,455 --> 00:22:04,022
Yeah.

441
00:22:04,022 --> 00:22:08,076
Maybe you ought to tell her to back off
a little bit and, again,

442
00:22:08,076 --> 00:22:11,430
you know, and about a year later,
my wife turns to me and says,

443
00:22:11,880 --> 00:22:14,883
you ever heard of cannabinoid hyperemesis
syndrome?

444
00:22:15,183 --> 00:22:15,667
Yeah, I've.

445
00:22:15,667 --> 00:22:17,019
I've seen it already. Yeah.

446
00:22:17,019 --> 00:22:17,619
Let me guess.

447
00:22:17,619 --> 00:22:20,405
Your friend got diagnosed
finally, right? Yeah.

448
00:22:20,405 --> 00:22:21,356
So. And she.

449
00:22:21,356 --> 00:22:24,142
And so she backed off
and now her symptoms are better and.

450
00:22:24,142 --> 00:22:24,459
Yeah.

451
00:22:24,459 --> 00:22:27,195
Know now she can use it
more in moderation.

452
00:22:27,195 --> 00:22:27,546
Yeah.

453
00:22:27,546 --> 00:22:30,849
So that diagnosis is really
I don't want to say all that it takes.

454
00:22:30,849 --> 00:22:30,999
Right.

455
00:22:30,999 --> 00:22:33,218
Because you have to make that choice
to scale back.

456
00:22:33,218 --> 00:22:38,440
Well it's it's really tough because people
are using, marijuana as a comfort.

457
00:22:38,440 --> 00:22:39,908
They're using it recreationally.

458
00:22:39,908 --> 00:22:42,911
They're they're,
you know, the people that develop this,

459
00:22:43,095 --> 00:22:45,847
syndrome,
you know, they're using it almost daily.

460
00:22:45,847 --> 00:22:48,517
And so it's become
a source of comfort for them.

461
00:22:48,517 --> 00:22:52,003
And now you have to tell them, you know,
that their body has turned against it,

462
00:22:52,154 --> 00:22:56,525
and now they can't use this, this product
that was giving them comfort.

463
00:22:56,525 --> 00:22:59,261
Maybe they're using it to help them
sleep, right?

464
00:22:59,261 --> 00:23:00,879
Maybe they're using it for anxiety.

465
00:23:00,879 --> 00:23:04,199
Maybe they're using it for nausea
and vomiting for whatever reason.

466
00:23:04,199 --> 00:23:07,919
And now you have to convince them
that this is the cause of their problem,

467
00:23:07,919 --> 00:23:11,406
and that that's sometimes that that's,
even with that, that, that medical,

468
00:23:12,074 --> 00:23:14,709
diagnosis
or that prescription to have it as well.

469
00:23:14,709 --> 00:23:14,976
Right.

470
00:23:14,976 --> 00:23:18,163
We know people have their medical cards
to consume marijuana.

471
00:23:18,163 --> 00:23:20,949
And how do you challenge that one? Right.

472
00:23:20,949 --> 00:23:23,535
Well, some a lot of it, you know,
some of it's the medical card.

473
00:23:23,535 --> 00:23:24,336
Yeah.

474
00:23:24,336 --> 00:23:27,105
You know, medical
marijuana is now legal in this state.

475
00:23:27,105 --> 00:23:27,939
Yeah.

476
00:23:27,939 --> 00:23:31,109
But you can also go out into any smoke

477
00:23:31,109 --> 00:23:35,714
shop in Wynwood or, you know,
you know, anywhere in Miami and buy,

478
00:23:36,882 --> 00:23:39,101
you know,
pretty much you can buy the whole year.

479
00:23:39,101 --> 00:23:42,037
Yeah. Yeah, it's out there
and it's very, very accessible.

480
00:23:42,037 --> 00:23:44,956
And is there anything else you want to add
before we close out?

481
00:23:44,956 --> 00:23:47,959
Tell me something about the poison
control center that nobody knows about.

482
00:23:48,460 --> 00:23:51,062
the poison control center,
we are located here at Jackson.

483
00:23:51,062 --> 00:23:54,182
I think a lot of people are surprised,
that we're actually here.

484
00:23:54,182 --> 00:23:56,601
But we are the poison center for, Broward.

485
00:23:56,601 --> 00:23:59,404
Dade, Monroe.
We in Collier County. County.

486
00:23:59,404 --> 00:24:02,307
We get about 50,000 calls per year.

487
00:24:02,307 --> 00:24:03,692
We do follow up calls.

488
00:24:03,692 --> 00:24:06,695
So it's more than just
those 50,000 calls, right?

489
00:24:07,379 --> 00:24:10,415
Our numbers have really been coming down

490
00:24:10,866 --> 00:24:13,468
over the past two decades or so.

491
00:24:13,468 --> 00:24:14,286
Good problem.

492
00:24:14,286 --> 00:24:17,272
Well, because people can now look up

493
00:24:18,273 --> 00:24:19,508
things on Google.

494
00:24:19,508 --> 00:24:21,176
Oh, on ChatGPT.

495
00:24:21,176 --> 00:24:22,327
Oh, now that I mean,

496
00:24:22,327 --> 00:24:25,447
I'm not saying to take it medical advice,
but if they need to look up,

497
00:24:26,248 --> 00:24:29,434
a pill ID, for example,
they mixed all their pills

498
00:24:29,434 --> 00:24:32,220
in the same bottle
and they think this is the one

499
00:24:32,220 --> 00:24:34,172
they're supposed to take
for their blood pressure.

500
00:24:34,172 --> 00:24:37,943
They can now use their phone to look up
what the name of that pill

501
00:24:37,943 --> 00:24:39,895
is, and figure out which bill is which.

502
00:24:39,895 --> 00:24:43,582
And so that has decreased
our overall calls.

503
00:24:43,765 --> 00:24:47,519
But our acuity,
the number of patients that are

504
00:24:47,519 --> 00:24:51,206
actually sick
has actually gone, gone much higher.

505
00:24:51,456 --> 00:24:54,943
I was going to ask that's a
that's a good segue to because I we're,

506
00:24:55,327 --> 00:24:56,645
to be quite frank with you,

507
00:24:56,645 --> 00:25:00,815
we're very I against
I for medical advice on this podcast.

508
00:25:00,815 --> 00:25:01,316
Right.

509
00:25:01,316 --> 00:25:04,286
AI is good for something
as a really have to know its limits.

510
00:25:04,286 --> 00:25:07,105
That's what most of our experts
say that use it as a tool.

511
00:25:07,105 --> 00:25:08,790
But not as your your failsafe.

512
00:25:08,790 --> 00:25:13,161
I think it's it's a long way
from, putting most of us out of a job.

513
00:25:13,979 --> 00:25:16,982
You know,
it is a useful tool in the right hands.

514
00:25:17,399 --> 00:25:22,320
I think anybody with a real
area of expertise can ask

515
00:25:23,855 --> 00:25:24,839
AI a question

516
00:25:24,839 --> 00:25:28,260
within their area of expertise,
and you realize what garbage it is, right?

517
00:25:28,677 --> 00:25:33,782
You know, the problem with AI is
it was developed to sell itself.

518
00:25:33,815 --> 00:25:34,266
Yeah.

519
00:25:34,266 --> 00:25:38,937
So I can ask AI a question
in a positive way, and it will answer me.

520
00:25:38,937 --> 00:25:40,021
Yes, you're right.

521
00:25:40,021 --> 00:25:44,092
And then I can ask the same question
in a negative way like this

522
00:25:44,092 --> 00:25:45,694
doesn't cause this, does it?

523
00:25:45,694 --> 00:25:47,846
And it will say, no, it doesn't.

524
00:25:47,846 --> 00:25:50,065
For the same question in the same chat.

525
00:25:50,065 --> 00:25:50,365
Right.

526
00:25:50,365 --> 00:25:51,182
So yeah.

527
00:25:51,182 --> 00:25:54,236
So it's really well, that's
why it's great to have experts

528
00:25:54,236 --> 00:25:57,722
like you in the poison control
that your, your hotline is 24 hours.

529
00:25:58,139 --> 00:26:01,443
Our hotline is 24 over seven, 365 days
a year.

530
00:26:01,560 --> 00:26:05,463
The phones are, run by either doctors,

531
00:26:05,463 --> 00:26:09,184
nurses or pharmacists
in our poison center in Miami.

532
00:26:09,384 --> 00:26:14,406
All of our, phone
operators are specialist are physicians.

533
00:26:14,756 --> 00:26:17,726
So, they're physicians, they get,

534
00:26:19,494 --> 00:26:21,246
a unique area of expertise.

535
00:26:21,246 --> 00:26:24,232
We have to train them
when they come to us.

536
00:26:24,516 --> 00:26:29,671
They really don't have any expertise,
nor does it's a very niche specialty.

537
00:26:29,671 --> 00:26:31,222
It's a very unique field.

538
00:26:31,222 --> 00:26:33,992
So we have to train them from scratch.

539
00:26:33,992 --> 00:26:38,797
After, 1 to 2 years,
they take a national certifying exam.

540
00:26:38,797 --> 00:26:42,384
So they become, certified poison
information specialists.

541
00:26:42,684 --> 00:26:46,204
And then if there's something
that they can't answer,

542
00:26:46,855 --> 00:26:49,507
then they they call me the expert.

543
00:26:49,507 --> 00:26:52,477
Yeah, well, 365 days a year.

544
00:26:52,477 --> 00:26:53,995
I take a lot of call.

545
00:26:53,995 --> 00:26:55,714
Always on call. I'm always on call.

546
00:26:55,714 --> 00:26:57,666
Thank you, Doctor Bernstein.

547
00:26:57,666 --> 00:26:58,883
And to our listeners,

548
00:26:58,883 --> 00:27:01,886
thank you for tuning in
to another episode of On Call Off script.

549
00:27:01,953 --> 00:27:04,956
Be sure to subscribe
so you don't miss our next conversation.

550
00:36:57,798 --> 00:36:58,249
We're done.

551
00:36:59,483 --> 00:37:01,285
Was that okay?

552
00:37:01,285 --> 00:37:03,054
Well, I think that was good.

553
00:37:03,054 --> 00:37:05,423
That was a good conversation.
It goes by fast.

554
00:37:05,423 --> 00:37:06,173
Yeah, yeah.

555
00:37:06,173 --> 00:37:08,859
I mean, you know,
when you put me on the spot, I.

556
00:37:08,859 --> 00:37:09,510
I'm sorry.

557
00:37:09,510 --> 00:37:13,247
You've always I got you know,
I think, you know, the funniest thing

558
00:37:13,247 --> 00:37:16,367
is the most common question I get asked
when people find out what I do is

559
00:37:16,851 --> 00:37:19,854
what's the craziest thing you've ever
It is like,

560
00:37:20,204 --> 00:37:21,906
I don't know, it's
the one put me on the spot.

561
00:37:21,906 --> 00:37:22,707
The one that gets the call.

562
00:37:22,707 --> 00:37:25,459
I can never reach my friend
I know I can never remember.

563
00:37:25,459 --> 00:37:27,862
Like I can never think of something
on the spot.

564
00:37:27,862 --> 00:37:31,249
That anecdotal story about your wife's
friend is a really good one, though.

565
00:37:31,282 --> 00:37:32,166
Yeah.

566
00:37:32,166 --> 00:37:35,987
And I and I yeah, I mean, I certainly
I've seen some crazy things, but I can't.