The Art of Manliness - Is Cannabis a Safe Drug？

00:00:00.000 Brett McKay here, and welcome to another edition of the Art of Manliness podcast.

00:00:11.540 Over the last decade, cannabis use has been legalized in more states.

00:00:15.220 At the same time, the idea that marijuana is a safe drug has steadily increased.

00:00:19.700 But is this an accurate perception?

00:00:21.460 Recent research by my guest, Dr. Ryan Soltan,

00:00:24.280 professor of clinical psychiatry at Columbia University,

00:00:26.620 casts some doubt on a universally affirmative answer to that question.

00:00:30.620 And he says we need to be having a more objective,

00:00:32.760 balanced, and nuanced conversation around cannabis than we currently are.

00:00:36.040 We have exactly that kind of conversation today on the show.

00:00:38.800 We dig into the fact that young adults are the group most vulnerable

00:00:41.500 to the potentially negative effects of cannabis

00:00:43.400 and how marijuana use in adolescence is linked to both mental illness and cognitive deficits.

00:00:48.300 Dr. Soltan impacts how cannabis impacts the developing brain

00:00:50.980 and may lead to schizophrenia, especially in males.

00:00:53.740 We also talk about whether if you used marijuana as a young adult and then stopped,

00:00:57.560 your brain can still recover,

00:00:59.040 and a cannabis-related health concern for all ages that doesn't concern the brain.

00:01:02.880 We end our show with Dr. Soltan's take on what the safe use of cannabis looks like for adults.

00:01:07.260 After the show's over, check out our show notes at aom.is slash cannabis.

00:01:10.480 All right, Dr. Ryan Soltan, welcome to the show.

00:01:26.580 Thank you. I'm excited to be here.

00:01:28.180 So you are a professor of clinical psychiatry at Columbia University,

00:01:32.420 and you've done a lot of research on ADHD in teenagers and young people.

00:01:37.380 Recently, you've been doing some research on cannabis and how it affects the psyche.

00:01:42.760 What led you down that research path?

00:01:44.920 So for me, I've always been interested in mental health.

00:01:48.180 At a young age, I identified it as something that I felt we weren't thinking enough about.

00:01:55.420 I'm in an age group where I think I feel much more acutely the historical stigma of mental health.

00:02:01.980 Obviously, it's improved, and so that led me on that path.

00:02:05.680 And ADHD was something I became very interested in for a variety of reasons.

00:02:10.640 One of the main reasons is I come from a family of people with ADHD.

00:02:13.860 I have ADHD, and I wanted to learn and understand more about it and how to treat it

00:02:18.100 and what's effective and why we have it and how does it fit into a historical context.

00:02:22.960 And I followed that for a while and really expanded my knowledge and expertise on that.

00:02:30.600 And as I was sort of coming to what felt like an end of that story for me,

00:02:37.240 at least from a research point of view,

00:02:39.100 I was really struck by how ADHD and substance use are just so, so linked.

00:02:45.540 I mean, they're like cousins.

00:02:47.580 They're very commonly connected to one another.

00:02:49.520 ADHD is a major risk factor for substance use.

00:02:52.780 And a lot of the ways we think about the brain and neurobiology,

00:02:56.720 there's a lot of overlap between ADHD and substance use.

00:03:00.500 And then the pandemic happened.

00:03:02.380 And like a lot of us, I was sort of thinking during the pandemic,

00:03:06.040 and marijuana was being discussed a lot.

00:03:08.460 And I noticed a very significant shift in attitudes around marijuana.

00:03:14.720 I went to high school in the 90s, late 90s.

00:03:18.400 And so I was on the tail end of like D.A.R.E. and like the drug wars.

00:03:22.800 And so, you know, it was very meaningful for me to see it being presented in this other way.

00:03:29.500 And as the pandemic was ending, you know, and I'm going out,

00:03:33.120 I'm taking my dog for a walk in the morning.

00:03:34.760 I live in New York City, I live in Manhattan.

00:03:36.700 I started noticing the number of people smoking weed on the streets.

00:03:39.760 I was like, okay, let's decriminalize now.

00:03:41.080 They can do that.

00:03:41.860 Though it seemed like a lot.

00:03:43.300 And I was a little struck by that.

00:03:45.500 But the thing that really struck me and disturbed me some is that I would regularly see teenagers

00:03:51.860 and middle school kids in Manhattan, in New York, in the morning before school, getting

00:03:57.800 high, like smoking joints, getting high.

00:04:00.360 And I would go up and I would talk to them about this and ask them questions.

00:04:03.500 And, you know, it's clear that they considered it to be a very benign thing.

00:04:07.100 And that's actually supported by survey data, which shows that most people now see marijuana

00:04:11.580 as totally benign.

00:04:13.540 And what I found to be really striking about it was that there's no way that this is benign

00:04:18.840 for them.

00:04:19.840 Like anyone who's ever gotten high would agree that you don't get high before you're going

00:04:25.000 to do something involved in learning, just like you wouldn't get drunk before doing that.

00:04:28.680 It's going to adversely affect your ability to learn.

00:04:32.160 And so that sort of put me on a course of like, what do we really know about cannabis?

00:04:37.280 Particularly what do we know about cannabis in teens?

00:04:39.960 And the more and more I learned about it, the more and more I realized we actually didn't

00:04:43.600 know very much at all.

00:04:44.660 That the information that we had was really rather dated because it was done before we

00:04:51.280 weren't allowed to do federally funded research around on cannabis.

00:04:54.320 cannabis and that it was not just dated temporally, meaning it was published a long time ago, but

00:05:00.180 it's obsolete because the cannabis of today is significantly more potent than the cannabis

00:05:07.340 of the past, depending on what you look at.

00:05:10.420 I mean, some of these places say that they have 90% potency cannabis.

00:05:13.940 The cannabis of like my parents' generation of like a hippie generation was like 3%, 5%.

00:05:20.320 So this increase in potency means we're not really dealing with the same substance anymore.

00:05:25.700 So like, do we know enough about this new substance?

00:05:28.320 How do we look at that?

00:05:29.040 How do we think about that?

00:05:30.400 So I really wanted to start to think about that and learn about that and understand and

00:05:34.760 expand our knowledge as a society around cannabis as we enter into this new phase where

00:05:40.660 use is going to increase really substantially.

00:05:44.020 It's funny.

00:05:44.580 You mentioned you've noticed in Manhattan, changing attitudes around marijuana and you're

00:05:48.940 seeing more people use it and, you know, openly.

00:05:52.600 I'm in Oklahoma.

00:05:53.800 We have medical marijuana, which is basically recreational marijuana because it's so easy

00:05:58.980 to get a marijuana medical license card.

00:06:01.980 There's billboards saying, hey, here's this doctor, get a card.

00:06:05.420 It's been interesting to see in Oklahoma, just out in public, you'll be at a kid's, my kid's

00:06:10.720 basketball game and in some rural, like small town in Oklahoma.

00:06:14.100 And maybe 20 years ago, you would have smelled like cigarette smoke on the parents in the

00:06:18.440 stands.

00:06:19.240 Now you just like, people smell dank.

00:06:20.900 I'm like, that's, that's interesting.

00:06:23.880 Yeah.

00:06:24.200 Just to see that shift that's happened, like really in like the past 10 years, it's, it's

00:06:27.680 interesting to observe that.

00:06:29.260 I think to sort of touch on the medical thing, you know, my, my frustration around legalization

00:06:35.500 of cannabis has not been the legalization of cannabis.

00:06:38.240 It's been when we pretend it's a medical thing, but it's not really a medical thing.

00:06:43.440 Like, let's be straight guys.

00:06:44.500 Like if, if we want it to be a legalized recreational drug and that's a decision we want to make

00:06:48.520 as a society, like let's make that, let's not pretend it's medicinal because the science

00:06:53.680 on like medicinal marijuana is not very strong.

00:06:57.860 It's really solid around like reducing nausea, weight gain.

00:07:02.720 Like it's definitely good at that acutely.

00:07:06.100 It's meaning like right after you use it, it usually reduces anxiety though in the long

00:07:11.800 term, when you use it continuously, it's pretty clear that it actually increases anxiety with

00:07:16.520 depression.

00:07:17.500 Again, it's probably going to make you feel better if you're not feeling very good at

00:07:20.920 the time and you're feeling down and depressed, but similar to alcohol, like it's not a permanent

00:07:25.580 improvement.

00:07:27.280 Often you end up needing, if it's a major coping mechanism for you, if you're using it medicinally

00:07:32.360 from like a mental health point of view, you need to use it more frequently and in higher

00:07:37.020 dosages to get the same effect.

00:07:40.140 And I think it's important that people understand that, that that's a trade-off that they're

00:07:44.280 making around that.

00:07:45.600 Well, let's dig into a recent study you did that looked specifically at cannabis use amongst

00:07:51.900 teenagers, young people.

00:07:53.500 And you looked at what's called non-disordered cannabis use and disordered cannabis use.

00:07:59.700 What's the definition of those and how are they differentiated?

00:08:01.900 And how'd you do that in your study?

00:08:03.700 Great.

00:08:03.880 So let's think about how to talk about this in a way I think that's helpful to your audience

00:08:09.660 because there's two sides of it.

00:08:11.220 I think some of it is a little more nerdy, science-y and other parts of it are a little

00:08:15.220 more useful and practical.

00:08:16.940 So, you know, one of the questions that I had for myself is as we're entering into this

00:08:20.560 world where cannabis is becoming a commonly used, openly and accepted recreational substance

00:08:29.880 like alcohol is.

00:08:31.360 We don't have as clear an idea on like what level of cannabis use qualifies as problematic

00:08:40.540 from like an addiction point of view versus what qualifies as just sort of like okay and

00:08:46.800 recreational.

00:08:48.340 And so what I wanted to do is try to understand that a little bit better.

00:08:51.420 So I wanted to start with teenagers because we know that teenage brains are still undergoing

00:08:58.140 development.

00:08:58.760 It's funny, you know, 18, you're an adult, but that number is very arbitrary.

00:09:04.100 Your mind is not done developing.

00:09:05.940 All of our minds are not done developing until we're 25.

00:09:09.260 If you have ADHD, it's probably like 27, 28.

00:09:12.480 And it continues to go through all these structural changes where, you know, your things are being

00:09:17.560 myelinated, which basically means like it's like upgrading your brain from like dial up to

00:09:21.740 like Fios or something like that.

00:09:23.840 So that's important because it allows your brain to develop more sophisticated thinking

00:09:29.480 skills like judgment and impulsivity gets reduced.

00:09:32.960 All those sort of higher level cognitive skills that come a little later in life and that are

00:09:37.740 really important.

00:09:38.620 And so the idea of exposure to cannabis during that time period is there's a lot of evidence

00:09:45.120 around that it changes some of that structural brain remodeling that occurs.

00:09:50.600 So I wanted to start with teenagers and get an understanding of that.

00:09:53.140 So what we did is, you know, we had about 70,000 12 to 17 year olds that we looked at.

00:10:00.500 And this is a nationally representative sample, which is really cool because it, it means like

00:10:04.760 whatever statements come out of this are statements that you can make kind of universally

00:10:09.520 around the entire U.S. population, as opposed to if I just talk to, you know, 70,000 random

00:10:17.040 teenagers, it's actually been done in a way that it encompasses large numbers of people

00:10:21.000 and the different demographics.

00:10:22.140 And what we did is we basically said, well, have you recently used cannabis?

00:10:27.980 And if you hadn't recently been using cannabis, you got put in the non-use category.

00:10:32.280 If you had recently used cannabis, we then had a second set of questions that were asked

00:10:37.280 of you.

00:10:37.480 And those questions are the questions used to diagnose if you have an official addiction.

00:10:43.100 And then if you qualified for having unofficial addiction, which you only had to answer positively

00:10:50.280 to two out of the 10 questions, then you had the substance use disorder.

00:10:54.140 If you didn't, you went in this non-disorder group, which is this group of people that are

00:10:57.940 saying they're using marijuana, but we can find no evidence that this is a substance use

00:11:02.800 problem.

00:11:03.280 So non-disordered, no substance use problem, disordered substance use problem.

00:11:09.020 Gotcha.

00:11:09.180 So it's like the difference between like maybe an alcoholic and then someone who has a drink

00:11:13.180 every now and then.

00:11:14.680 Mm-hmm.

00:11:15.280 Okay.

00:11:15.960 So this study looked at a couple of things and one was the prevalence of this non-disordered 1.00

00:11:21.020 cannabis use.

00:11:22.120 So young people who responded to the survey say, I use it, but I'm not addicted.

00:11:25.880 What did the study uncover on that front?

00:11:28.000 So what we found is, and again, among recent marijuana users, this is not I've ever used

00:11:33.540 marijuana, more of these are people that are probably using marijuana regularly at this

00:11:37.660 time, that the people with non-disordered ones, the ones that are recreational, they're four

00:11:41.800 times as common as those that meet the criteria for having a problem that we would say with their

00:11:48.960 cannabis use.

00:11:50.220 So overall about like 13% of US teens between 12 and 17 had recent cannabis use.

00:11:56.320 And maybe like two and a half to 3% of them had that kind of addictive stuff going on.

00:12:02.540 Then that other rest of them, the 10% are using, but they don't qualify as having a substance

00:12:07.560 use problem.

00:12:08.780 When you did the survey and you got the results back, was the rate of cannabis use, whether

00:12:12.460 non-disordered or disordered, was it higher or lower than you expected?

00:12:16.560 It's lower than I expect.

00:12:18.020 And part of that may be I live in New York City, and it's a very progressive city.

00:12:26.860 And in a post-pandemic world, it is disturbingly easy to get cannabis.

00:12:31.760 There are all these little like pop-up, not legal, unlicensed cannabis shops that have proliferated.

00:12:38.780 So to me, that number feels lower.

00:12:41.460 But you got to remember, we're averaging, right?

00:12:42.600 So like my good buddy lives in Montana, and I spent a lot of time out there with him and

00:12:48.280 his family.

00:12:49.380 And I'm pretty sure that that rate is a lot lower in Montana.

00:12:53.920 So we're getting an average.

00:12:55.060 So that explains part of it.

00:12:57.100 And then the other part of it is when you ask someone, and this isn't just teenagers,

00:13:01.980 this is you and me too.

00:13:03.100 You ask them like, how much do you smoke?

00:13:05.800 How often do you smoke?

00:13:06.920 Or you ask them, how much do you drink?

00:13:09.320 How often do you drink?

00:13:10.220 We're all lying.

00:13:11.480 And we're lying to ourselves.

00:13:12.920 Not lying intentionally.

00:13:14.940 We're lying because like, I don't know, like, we all want to believe in our head that these

00:13:19.520 things are happening less often than they actually are.

00:13:21.740 And I can tell you from, you know, my own personal experience doing this activity, friends,

00:13:27.760 family, and serving a lot of patients where I say like, actually, let's log what you're

00:13:31.460 doing.

00:13:31.700 Let's actually like, write it down every day, that people are always underestimating

00:13:37.720 it, right?

00:13:38.200 So another factor may be that people are underestimating it.

00:13:41.540 And that's something that we've seen.

00:13:43.420 And it's a huge problem, actually, from a research point of view, is that because people

00:13:47.460 underestimate it, it makes it harder to study it.

00:13:50.320 Are there historical surveys about cannabis use amongst adolescents?

00:13:53.800 So do we know if it's increased or stayed the same over time?

00:13:57.380 Yeah, the general trend is that it's increased.

00:13:59.420 Depends on what time period you look at.

00:14:01.420 But in the last 12 years, there's been almost a doubling in the frequency that a teenager

00:14:08.980 would report that they've used cannabis.

00:14:11.380 You mentioned earlier, one of the things you were wanting to explore in terms of marijuana

00:14:15.580 that got you thinking about it was this change in perception of cannabis safety.

00:14:22.320 And I guess over time, it's been seen as more safe.

00:14:24.240 Is that what your research is finding?

00:14:26.280 Yeah, that's absolutely been shown.

00:14:28.060 So in that same time period of the last 12 years where I said that we've almost doubled

00:14:33.400 the number of youth that say they've used cannabis, if you ask the same question, and

00:14:38.160 the data from this study comes from a National Institute on Drug Abuse who actually funded

00:14:43.500 my research as well.

00:14:44.700 And they do this very comprehensive survey every year.

00:14:48.060 And so they ask the same questions.

00:14:49.880 So we can look at it.

00:14:51.440 So if you look in the past, so like 10 years ago, 50% of people would have said yes to the

00:14:58.000 following question.

00:14:58.700 I think that weekly cannabis use is safe and not harmful.

00:15:04.580 Now it's 75-80% of the population say that.

00:15:09.460 Wow.

00:15:09.860 Okay.

00:15:10.100 That's a big increase.

00:15:10.860 Which is like, I mean, that's like almost everyone, right?

00:15:14.780 I mean, that's a lot of people.

00:15:18.140 And especially among kids.

00:15:21.040 Among adults, I think the jury is out around what is the actual risk associated with that.

00:15:28.260 Um, but among youth, it's, that's pretty much not true that there is no negative effects

00:15:35.580 associated with it.

00:15:36.280 Even before the study that, that I did, the one that we're talking about, there are stacks

00:15:41.360 of research papers, uh, from many different avenues discussing how cannabis use in young

00:15:50.300 brains seems to change actually how the brain develops, the morphology of the brain, the

00:15:56.240 connections that are being made, it clearly causes cognitive impairments.

00:16:00.460 I mean, anyone who's ever gotten high and tried to do math will tell you that it causes

00:16:04.620 cognitive impairments and that those cognitive impairments persist in many cases, six weeks

00:16:09.900 out, like six months out.

00:16:12.220 And, and that long-term cannabis use starting in younger years can be associated with like

00:16:16.640 an eight point drop in your IQ.

00:16:19.220 So my point, I guess, is that that's at least among youth, that that's actually not really

00:16:25.900 an accurate perception.

00:16:27.840 Well, let's dig into this guys.

00:16:28.680 The second thing this study looked at was what adverse effects are associated with, with

00:16:33.100 non-disordered cannabis use.

00:16:34.500 These are teenagers who are smoking marijuana maybe a couple of times a week, but they're

00:16:37.940 not addicted or whatever.

00:16:39.340 So you mentioned some of the adverse effects of cognitive decline.

00:16:43.020 What are some other ones that you found in your study?

00:16:45.740 I love that you said associated.

00:16:47.640 That makes me so happy that you are making that distinction.

00:16:51.520 I've had, I've had multiple podcasts on this and I've had to, I've had to like jump

00:16:54.300 and I'm like, stop saying effect.

00:16:55.840 We can't prove that.

00:16:57.280 So associated is right, right?

00:16:58.460 So it's really hard to prove causality in science.

00:17:02.380 In the things I'm about to talk about, there is a fair line towards causality because we

00:17:07.360 have multiple different lines of evidence, multiple different ways showing something

00:17:12.100 similar that these things are problematic.

00:17:14.200 But what I was trying to do is figure out like, what I was actually really curious about

00:17:17.560 is like, all right, so by definition in, in, in psychiatry, we make the cutoffs for what

00:17:23.780 we consider to be an addiction, what we consider to be a substance use problem.

00:17:27.000 We make those cutoffs based on like, is the thing having a negative impact on them?

00:17:32.220 And so I was like, okay, so like we would expect that the ones that have a substance

00:17:36.300 use problem, that they're going to have higher rates of depression, higher rates of suicidal

00:17:42.380 thoughts, cognitive problems associated with the cannabis, truancy, they're not going to

00:17:47.740 school, their GPA is going to be poor, that they're going to get into delinquency problems.

00:17:53.460 You would expect that.

00:17:54.300 That's very consistent with the definition.

00:17:57.280 What I was surprised by was that when we looked at these non-disorder guys, right? 1.00

00:18:01.040 So these are the ones that do not meet the criteria for a substance use problem, that they

00:18:06.940 also had increases in their likelihood of having a recent major depressive episode, having

00:18:13.060 suicidal thoughts, skipping school, having a low GPA, and those were meaningfully higher

00:18:18.400 than you would if you reported yourself as a not recent user.

00:18:23.080 Okay.

00:18:23.340 So right now we can just see correlation, maybe some causation.

00:18:27.560 There are some, you've said there's, there are some studies that show maybe there is some

00:18:30.260 causation going on.

00:18:31.680 Yeah, absolutely.

00:18:32.640 And when we think about it, like, like, so let me, let me sort of tell you how I think about

00:18:36.600 so when this first came out, I'm on Reddit a lot, I like Reddit, I think it's fun.

00:18:40.740 So there's this section on Reddit called Science, and it's definitely one of the like

00:18:44.520 meatier Reddit groups, certainly that I'm a part of.

00:18:47.500 And so it pops up and I see this article that of course catches my attention because it's

00:18:53.780 about cannabis use in teens, and I realized it's actually my article.

00:18:57.140 And I'm like, okay, so I'm like clicking on this, and it has like over 3,000 comments,

00:19:03.220 which is like, that's like a lot of comments, right?

00:19:05.120 But it actually never rises to a level where it gets a high rating.

00:19:09.940 I don't know if you're on Reddit, like you can down and upvote things, so you can undo

00:19:13.200 people's likes.

00:19:14.560 And it was close to neutral.

00:19:16.500 And I was like, what's going on here?

00:19:17.840 And there were so many people up and downvoting it.

00:19:20.880 And so I was like, okay, let's take a look at this.

00:19:22.480 So I went under the comments, and it was so clear how this, to get into this idea of causation,

00:19:29.520 how people's views were very different on it.

00:19:31.400 So we had like two main groups.

00:19:33.140 So one group was the, this proves what I already know, that cannabis is BAD bad.

00:19:40.420 My uncle, my sister, my brother, my niece, you know, they were using cannabis, and it

00:19:47.760 made their depression worse.

00:19:49.060 Like, of course.

00:19:50.280 And then you had this other group of people that said, no, no, no, no, no, you have it

00:19:54.460 all wrong.

00:19:55.360 You have it all wrong.

00:19:56.180 The cannabis has nothing to do with this.

00:19:57.660 They just happen to be using cannabis because they're already depressed, and they're using

00:20:02.740 it to moderate and improve, you know, their symptoms and quality of life and reduce their

00:20:08.220 anxiety.

00:20:09.320 And so there was a lot of these disagreements going back and forth.

00:20:11.560 And for me, what I think is really important about that, and the way I think to frame the

00:20:16.520 findings that this study has, which is this association with depression and suicidal thoughts

00:20:22.420 and poor academic performance among people who, kids who use cannabis, but don't have

00:20:27.900 like an addiction, is that there's a negative feedback loop that happens, right?

00:20:31.860 So let's imagine that we have a young person that is predisposed to depression.

00:20:39.360 Maybe they're not depressed at the moment.

00:20:41.760 So they have a genetic predisposition, some things go on in their life that might set

00:20:45.900 it off.

00:20:46.460 There's trouble at home.

00:20:48.160 Maybe they change schools.

00:20:49.620 They're not having a good social situation.

00:20:51.960 They use cannabis.

00:20:52.880 Maybe they even use it with their friends.

00:20:54.180 They vape.

00:20:55.000 And if they're not feeling great, the cannabis may temporarily, will probably temporarily make

00:21:01.560 them feel better.

00:21:02.760 And so there's a relief that comes from that.

00:21:05.020 Now, the problem is that let's say we keep doing that.

00:21:08.420 Let's say that this becomes like a regular coping strategy for someone.

00:21:12.540 The repeated use is definitely not going to improve your depression, right?

00:21:16.380 That is not a treatment for depression.

00:21:17.880 We have not found it to be a treatment for depression.

00:21:19.280 We have many treatments for depression that are very useful.

00:21:22.360 This is not one of them.

00:21:23.700 But that it's more likely actually to worsen their depression over time, to worsen their

00:21:27.500 anxiety over time.

00:21:29.380 You can imagine someone that is getting high regularly.

00:21:33.000 They're going to be lower energy.

00:21:34.920 They're going to stay at home more.

00:21:37.220 So fewer social encounters, which that's a predictor for depression.

00:21:41.460 Their academic performance is not going to improve.

00:21:44.300 Anything that's going to get worse under this.

00:21:46.300 So it becomes like a feedback loop where you may have entered into this feedback loop with

00:21:51.660 the relief that comes from this.

00:21:53.760 You might even have been predisposed to getting these things.

00:21:56.020 But that if you develop sort of regular use, that you're actually setting in motion, potentially

00:22:02.480 like a snowball effect that just keeps making this worse for you.

00:22:05.860 Okay.

00:22:05.960 So kids might be starting marijuana to self-medicate because they have anxiety, depression, etc.

00:22:10.100 But then the marijuana use will just exacerbate those problems in the long run.

00:22:15.300 For many, right?

00:22:16.080 I mean, and not everyone, right?

00:22:17.920 Like I was in a meeting yesterday with a number of people that are interested in cannabis and

00:22:21.900 want to do some like testing on it.

00:22:23.740 And they were all talking about when they first started using cannabis.

00:22:27.180 And many of them started using when they were younger and they've gone on and done okay.

00:22:31.420 Like not everyone is going to have those issues.

00:22:34.080 But that the likelihood of them going up is significantly increased.

00:22:37.080 And so like in my study, you know, you're going to find that there's a 200% to 400% increase

00:22:43.560 in the likelihood of having a major depression, of having suicidal thoughts, of having these

00:22:49.220 cognitive impairments, of skipping school, of having a low GPA.

00:22:53.740 Um, they're going to be, uh, a lot higher, a lot higher, not as high as if you had a substance

00:22:59.300 use problem like that official addiction, but, um, meaningfully higher than if you are

00:23:04.880 not using cannabis.

00:23:06.020 Okay.

00:23:06.500 So even the non-disordered cannabis users experience significantly higher mental and behavioral

00:23:13.080 problems than non-users.

00:23:15.200 And, and, you know, like if someone wants to look up the article, they can, they can Google

00:23:18.860 it.

00:23:19.160 It's a open source article in JAMA network open.

00:23:21.560 Um, and you can actually look at the, the figure one is a great table that explains it.

00:23:25.820 It's just Google salted non-disordered cannabis use.

00:23:28.720 It should come up.

00:23:29.620 It's actually looks like steps, right?

00:23:31.560 So it's step one is non-users.

00:23:34.620 Then it's like a histogram.

00:23:35.800 So then the next bar is, you know, almost double and that's the non-disordered users. 0.99

00:23:40.400 And then the next bar is increased even more.

00:23:42.880 And those are the people with addiction.

00:23:44.220 So it's a stepwise trend.

00:23:45.800 I'm doing another analysis now that looks at it based on frequency of use.

00:23:49.760 And it's pretty clear that frequency of use follows this same pattern, right?

00:23:53.900 So the more that you're using, the worse these outcomes are.

00:23:58.160 We're going to take a quick break for your words from our sponsors.

00:24:02.380 And now back to the show.

00:24:04.560 Another adverse outcome I've seen lately in the news is schizophrenia.

00:24:08.480 The connection between marijuana use and young people and schizophrenia later on in life.

00:24:13.940 What is that research showing?

00:24:15.800 You know, it's as compelling as what we're talking about now, a bit to me more disturbing in some ways.

00:24:22.060 So schizophrenia is like a super serious condition.

00:24:25.800 It's a neurodegenerative disease and it really alters a person's life course.

00:24:32.740 And it significantly affects their family members.

00:24:35.460 So it's really something that we want to be doing everything we can to prevent.

00:24:39.660 Because once someone has it, our treatments for schizophrenia are, they're fine and they help, but they're really not great.

00:24:47.660 Like out of all of our mental health conditions, it's probably one of the ones that we have the poorest ability to treat.

00:24:53.100 So, you know, in thinking about how to prevent that, there's just been this thing that we've noticed for a long time, which is that people, when they first develop schizophrenia, which tends to develop like late teenage years to around 30, that the likelihood that that person has a positive urine drug screen or reports recent cannabis use is like really, really high.

00:25:15.980 And in fact, when I have a new episode of schizophrenia or psychosis, we could generally describe it as, I mean, it's the exception, not the rule when you test their urine and it's not positive for cannabis.

00:25:28.440 So we noticed this link, and there's been multiple studies, there was just another recent study on this, where it looks like in, certainly in guys, this is more true for men, between the age of like, I think 18 to like 26, cannabis use increases the likelihood of this development of schizophrenia by four times.

00:25:49.180 Wow.

00:25:49.340 Which is a lot, right?

00:25:51.440 I mean, for me, one of the things I talk about, because I work with a lot of young people, and when they're using cannabis, or if they're thinking about it, my thought is always like, look, if you want to use cannabis, that's your decision, like, okay, but like, if you want to go off the scientific research, it actually would say that you should wait until you're around 25.

00:26:09.300 This risk of schizophrenia drops really substantially, the association between cannabis and schizophrenia is not nearly as strong later on.

00:26:19.220 And the idea is like, your brain is still developing, getting back to this, my brain is not developed, my brain is not developed, like, you know, schizophrenia is very much a disease of your brain, a condition of your brain.

00:26:27.820 And so, when you have cannabinoid receptors, which are these receptors that we all have, that cannabis binds to, and by the way, we all have our own internal cannabinoids that your system just makes on their own, right?

00:26:39.280 Just like you have testosterone, and you could take exogenous testosterone, you're taking exogenous cannabinoids, they're actually much stronger than your cannabinoids, and there are these receptors all over your brain.

00:26:48.680 And so, when your brain is developing, you know, it's easy to see how exposure to these things is going to disrupt the development of your brain, and potentially increase the risk of depression, anxiety, definitely schizophrenia, and certainly also the risk of not being able to manage substance use later in life.

00:27:07.680 Because, you know, one of the things that I think we all struggle with is, you know, okay, you can drink alcohol, but can you drink alcohol in a way that it is overall giving you a net gain in your life?

00:27:20.160 And so, what's that question with cannabis?

00:27:21.920 Like, where do we sort of draw that line in terms of what is an appropriate amount that people are using, and what is an age to start at?

00:27:29.840 So, when I talk about this with youth, I really encourage them to wait until, like, 25, because the science really says that your brain is now done developing at that time period, and the likelihood that when you're an adult, that if you use alcohol, if you use cannabis, or use another substance that's potentially addictive, that you use it in a healthy way, meaning, like, it doesn't end up causing problems in your life, is much, much, much higher the later you start.

00:27:55.800 The earlier you start, the likelihood that it's a problem is significantly higher.

00:28:01.840 Okay, we've been talking about there's a correlation causation, there's research that there is a causative factor going on.

00:28:07.640 So, you mentioned what might be going on, so these cannabinoids are somehow disrupting the developing brain.

00:28:13.420 Like, do we know exactly what's happening to the brain, particularly a young person's brain that, you know, the THC or whatever it is, disrupts the development?

00:28:22.600 Like, do we have an idea of what's actually going on?

00:28:24.480 Well, we have a pretty good idea around it.

00:28:26.780 I mean, your brain's development is, I mean, it's, the levels of complexity around it are mind-boggling.

00:28:33.960 I've been in training for mental health and neuroscience and the brain for many, many, many years.

00:28:40.660 I guess it probably started for me in, like, 2007.

00:28:44.420 I have been in a research track on this now for five years, and I'm still learning around the complexity of that.

00:28:50.620 But, like, very broadly, very broadly, the cannabinoid receptors play a role for teens in what happens to your brain and how it develops.

00:29:00.240 How does it prune properly?

00:29:01.580 How much gray versus white matter that you have?

00:29:04.460 The morphology and size of different parts of your brain.

00:29:07.860 And there are a lot of studies, I was actually just flipping through it before we got on, that consistently show changes in the morphology of the brain, as well as tests that test how well your brain is working.

00:29:22.360 Like, how quickly can you think of something?

00:29:24.260 How well can you remember something?

00:29:25.660 Very consistently shown in everything from rodent models through actual people.

00:29:32.760 And so, when, in science, you keep finding the same or similar things in different places, that's usually a really good signal that there's something going on there.

00:29:42.140 So, when you say morphology, is that like the size of the brain?

00:29:44.760 The size, yep.

00:29:46.080 Mostly referring to, like, atrophy.

00:29:47.540 So, you guys see your brain gets smaller if you use marijuana early in adolescence?

00:29:51.580 Parts of your brain.

00:29:52.420 Like the prefrontal cortex might be, that's probably where a lot of that gets hit hard.

00:29:57.560 So, that's what's developing when you're an adolescent, is that prefrontal cortex.

00:30:01.380 And you want it to develop, right?

00:30:02.780 Like, so this is really important.

00:30:04.300 Like, you know, one of the jokes I make is like, your car insurance goes down at 25.

00:30:09.080 Do you know why your car insurance goes down at 25?

00:30:11.400 Because you have fewer accidents.

00:30:12.540 Do you know why you have fewer accidents?

00:30:13.720 Because your prefrontal cortex has been developed.

00:30:17.140 Right.

00:30:17.460 And you can make much better decisions.

00:30:20.000 You can gauge size.

00:30:21.620 You can predict things much better.

00:30:23.180 Your judgment has been improved.

00:30:24.760 Your impulsivity has dropped substantially.

00:30:27.220 So, you mentioned also, I just want to recap this.

00:30:30.260 The earlier you used marijuana as a teenager, you're probably going to have those adverse effects compared to later, correct?

00:30:37.580 Yeah.

00:30:37.800 So, there's several things.

00:30:38.920 So, like, the likelihood of having depression.

00:30:41.880 The likelihood of having suicidal thoughts.

00:30:44.880 The likelihood of having poor academic performance.

00:30:47.980 The likelihood that you go on to actually have a substance use problem, right?

00:30:53.700 Is all very highly linked to when you start using.

00:30:58.400 Let's say, you know, there's a person who started using cannabis 15, 16.

00:31:04.720 They got really into it and then they stopped.

00:31:07.780 Is there a risk of increasing mental deficits or mental illness later on in life?

00:31:12.720 Is it still going to be higher than if they'd never used the stuff?

00:31:15.800 Yeah, I think we can say pretty confidently that they put themselves on a different trajectory, but that the decision to sort of limit that use later is also putting them on a different trajectory than if they had stayed on that.

00:31:27.780 And that there is evidence.

00:31:28.700 There's one study that shows that long abstinence, like eight years, that the brain seems to heal itself.

00:31:34.580 And that in that eight-year time period, which is like a long time, that their brains looked fairly similar to controls.

00:31:44.400 There were some differences, but there is some healing that goes on, which is cool, right?

00:31:48.140 Like, we used to think that the brain, I was taught in high school, like, your brain can't regenerate, it can't regrow, but that's actually not true.

00:31:54.200 You know, it can.

00:31:55.160 Okay, so marijuana use as a teenager can increase severe depression, anxiety.

00:31:59.960 I think also suicidality was another thing you looked at, schizophrenia.

00:32:05.080 But then also, I think you mentioned it also affects you cognitively.

00:32:08.060 You'll have cognitive deficits that are associated with cannabis use as a teenager.

00:32:11.280 Like, your IQ will be lower, correct?

00:32:13.580 Yeah, I mean, this is like one of the things I wish actually, people want to talk about, like, the mental health from, like, a depression, suicidal, schizophrenia point of view, and those are super important.

00:32:22.060 As a person who is sub-specialized in, like, child and adolescent psych, I think a lot about learning and development from a learning point of view.

00:32:32.140 And, you know, your job, until you are 18, your primary job is to go to school.

00:32:37.920 Your primary job is to learn.

00:32:39.540 You know, we have a whole school system set up to hopefully help you develop critical thinking skills,

00:32:45.560 help you learn knowledge that's going to help you and assist you in your life, whether it's at a trade school,

00:32:52.620 whether it's a intellectual academic activity, and that's your main job.

00:32:58.680 And regular marijuana use is unequivocally disrupting your ability to do that.

00:33:05.640 And if the marijuana use is moderating a problem you have, like anxiety or depression, I get that.

00:33:12.260 But it's really not a great way to treat that.

00:33:17.060 There are much better ways that we have to treat that, that are not going to impair your cognition and your learning.

00:33:25.080 Which is, I guess, I just, I find that very upsetting because I want young people to be learning.

00:33:33.540 Right, right.

00:33:34.240 You know, your brains are primed to learn at that point.

00:33:37.580 They're actually really good at learning.

00:33:38.740 So you mentioned, you saw this with your Reddit post that got a lot of comments,

00:33:43.240 but it seems like whenever people bring up possible adverse effects associated with cannabis use,

00:33:48.360 there's a pushback.

00:33:49.320 People are like, well, no, actually, you know, it could be this, that reason why people use marijuana.

00:33:54.000 It's not the marijuana.

00:33:55.140 Some people seem really invested in seeing cannabis as a safe drug.

00:33:58.360 What do you think is going on there?

00:33:59.360 Why the pushback?

00:34:00.800 I mean, there's a lot going on there.

00:34:02.180 I think at a basic level, there's a whole group of people that feel incredibly validated now that something that was demonized for so long is being given credit as at least not being the incredibly detrimental drug that it was portrayed as.

00:34:23.260 And that was wrong, right?

00:34:24.200 Like marijuana is not as evil as we were told historically that they're right about that.

00:34:30.440 But, you know, I think that that's one aspect of it.

00:34:33.660 I think another aspect of it is that there's a lot of people that are trying to capitalize on this, you know, from a development of products point of view in the U.S.

00:34:43.080 So there's a lot of PR being done around marijuana.

00:34:48.440 And so people are becoming more comfortable with it.

00:34:50.160 And that's a snowball effect.

00:34:51.440 Like the more people are comfortable, the more other people become comfortable, the more we talk about it.

00:34:57.120 And so I think that we're still on the upswing of marijuana is great, marijuana is great, marijuana is great.

00:35:02.620 It's totally fine.

00:35:03.620 But for me, as someone who's thinking about this, I think a little more bird's eye view than the general public, I think that we are, the pendulum has now swung too far to the other side.

00:35:17.320 And that we need to sort of step back and start saying, wait a second, like marijuana is actually not a panacea treatment for everything.

00:35:24.180 That's just crazy and wrong.

00:35:25.980 That it's not totally benign.

00:35:28.460 That we need to be thinking about what are appropriate limits and sets of limits.

00:35:33.240 Also, what are quality control things?

00:35:34.600 So the meeting I had yesterday that I was mentioning to the people who had said they had used at different ages,

00:35:39.440 one of the things we're doing is actually trying to use advanced organic chemistry methods to take samples of marijuana and evaluate essentially the purity of them, the quality of them.

00:35:53.520 Do they have pesticides in them?

00:35:55.420 You know, how much of them is actually the THC cannabis or CBD product that it's supposed to be and how much of it is other stuff?

00:36:01.640 And our preliminary results suggest that it's much more heterogeneous than you would like it to be, as opposed to alcohol, which is not.

00:36:11.740 It's alcohol is highly regulated and you know what you're getting and you're not going to go buy alcohol at a liquor store and be worried that it's poisoned with something.

00:36:20.760 Yeah, it's laced with fentanyl or something like that.

00:36:22.760 I mean, God, we have not found that.

00:36:24.920 I mean, we were joking yesterday that like, are we going to find that?

00:36:29.540 Like, we have not found that yet.

00:36:30.780 I mean, that would be really upsetting.

00:36:32.400 Like, even if we took, say, 500 samples and one of them was laced with fentanyl, I think that would still be really, really upsetting.

00:36:39.880 I think that's one thing we'd have to worry about.

00:36:41.480 But there's also other things we have to worry about.

00:36:43.120 Like, this is a plant that people are growing.

00:36:45.200 So, like, are they using pesticides?

00:36:46.800 Like, what compounds are they using to get the thing to grow?

00:36:49.880 What things are they using to dry it?

00:36:52.300 You know, what things are being added on?

00:36:53.960 And that's happened already and hit the news.

00:36:56.600 Like, if you remember the whole vaping thing that happened, where all these people were getting these lung illnesses from vapes, and they were putting some sort of, I can't remember what it was, but some sort of compound that they were using to sort of like clean or extract it was incredibly toxic.

00:37:13.560 Incredibly, incredibly toxic.

00:37:15.880 And I worry about that with cannabis.

00:37:17.320 So, you know, there's another study that came out that, again, is really, I think, very impactful to me.

00:37:22.040 So, like, you know what a chest x-ray is?

00:37:23.960 We scan your chest.

00:37:24.840 We see what it looks like, right?

00:37:25.800 We do chest x-rays to look for lung cancer.

00:37:28.900 We do chest x-rays to look for pneumonia.

00:37:31.300 We do chest x-rays to look for emphysema, COPD.

00:37:35.160 Emphysema, COPD, lung cancer have been dropping for a long time because, you know, cigarettes are just nails in your coffin.

00:37:42.540 Like, we worked really hard to get people to stop smoking.

00:37:45.320 So, what they did is, they did a study where they looked at people that didn't smoke anything at all.

00:37:51.300 That's a group of people.

00:37:52.340 People who smoke cigarettes regularly, that's a group of people.

00:37:55.280 And then people that smoke marijuana regularly.

00:37:57.820 And when I saw this, like, as a headline, I was like, why is this so a big deal?

00:38:02.580 Of course, it's going to show that the cigarette smokers have the worst ones.

00:38:04.980 We all know cigarette smoke is bad and there's all these nasty things in it.

00:38:08.520 Nope.

00:38:09.720 Overwhelmingly, the cannabis users' lungs looked the worst.

00:38:12.340 And they were at the greatest evidence and risk for COPD and emphysema.

00:38:18.300 And I was, like, shocked by that.

00:38:21.260 Like, I have been talking to everyone who uses marijuana since then.

00:38:24.320 And I was like, can you please use it in, like, another way?

00:38:27.100 Like, take an edible.

00:38:28.440 Like, let's, you know, can we at least use, like, I don't know, maybe like a bong and the water cleans it?

00:38:33.200 Like, when the, you know, if you've ever seen a bong, it gets very dirty at the bottom.

00:38:37.380 And I always think, well, that's good.

00:38:38.840 That's not going in your lungs.

00:38:41.680 So, you know, there's a lot around this.

00:38:43.420 And I think that getting back to your idea of, like, why are we so unwilling to hear the other side of this?

00:38:50.220 You know, I think the pendulum has been really kind of swinging too far to the other side.

00:38:55.920 And we need to pull it back a little bit and really think about this objectively.

00:39:01.380 There's a theory we talk about in psychotherapy that Melanie Klein developed. 0.79

00:39:05.460 The idea of, like, being able to see a whole object.

00:39:08.000 Being able to see the good and the bad of it.

00:39:09.540 It's referring to people, right?

00:39:10.480 So, like, instead of just seeing a person as all good and you love them or all bad and they're terrible.

00:39:15.060 You're like, well, actually, people are a mixture of, like, good and bad things and everyone is.

00:39:18.560 Marijuana is the same way.

00:39:19.780 It's a mixture of good and bad stuff.

00:39:22.200 And we have to be objective in really thinking about where it lies on this good or bad mixture.

00:39:29.160 And educating the general public so that they can make an informed decision.

00:39:33.760 Now I'm talking about adults.

00:39:35.720 They can make an informed decision about whether they want to use this stuff.

00:39:39.700 Like, and, like, what the advantage might be for them and what are the potential disadvantages for them.

00:39:44.160 Well, you've said that you're looking at this from a bird's eye view.

00:39:47.320 What do you think are the possible societal implications of the rising rates of cannabis use amongst particularly young people?

00:39:54.140 Because that's what you're focused on.

00:39:55.180 Like, long term, are there problems we might be seeing because of the rising use that we're not seeing now but we will later on?

00:40:01.440 I mean, my hope actually is that we do enough research that is then available to policymakers.

00:40:07.940 Because right now, like, states have made their own decisions.

00:40:10.180 They're, it's a little bit of a free-for-all that creates a safe environment and promotes safe use of cannabis.

00:40:18.460 And that we actually don't have these problems.

00:40:19.740 That's actually really, like, where we're hoping to go.

00:40:22.180 And I think it's not too late for that.

00:40:24.140 But what would be my concern?

00:40:25.760 My concern is for smoking cannabis.

00:40:29.620 My concern is lung diseases across the board, particularly in youth, the earlier you start.

00:40:35.760 My concern is that it is halting the development of whole groups of kids that are not going to progress in their life in the same way that they would have.

00:40:46.880 Because they're more likely to have these mental health conditions, because they're less likely to be engaged appropriately in their scholastic environments, because they're having cognitive problems.

00:40:59.860 And that that's really unfair to them.

00:41:02.220 You know, and I feel like, you know, I'm going to get on a soapbox for a second here.

00:41:05.920 I feel like we're failing them as a society, you know, by permitting that to occur.

00:41:11.500 And there's a lot of parents that are not concerned about it, because they've been told and given their impression not to be concerned about it.

00:41:18.780 One of the take-home messages that I try to give to people about this is like, look, whether you believe that cannabis is causing these problems or not, like, let's even forget about that.

00:41:30.200 The bottom line is, when you look at large groups of kids, as large a group of kids as you can look at in the U.S., these things are linked.

00:41:38.700 So at the very least, they're a risk marker.

00:41:41.160 They're an indicator.

00:41:42.300 So if you know a teenager, and you're an educator, you're a parent, you're a relative, you're a healthcare provider, and they're using regular cannabis, your antenna needs to go up.

00:41:55.020 Your antenna needs to go up and say, wow, actually, this kid is two to four times more likely to have a depressive episode, to have suicidal thoughts.

00:42:03.460 They're way more likely to be performing poorly in school, skipping school, having cognitive problems.

00:42:12.500 Like, what do I need to do to make sure that they don't have that?

00:42:15.120 Like, I need to screen them.

00:42:16.220 I need to keep an eye on this, make sure that's not what's going on with them.

00:42:20.460 And if they're having those problems, which statistically they probably are, how do I help them, right?

00:42:27.360 How do I intervene in a way?

00:42:29.540 So take depression.

00:42:30.540 Like, there's many ways to treat depression.

00:42:32.860 Physical activity is a well-documented way to improve depression.

00:42:37.040 Exposure to nature is a well-documented way, protective for depression.

00:42:41.660 Improving social relationships, connections between family members and peers, very great way to improve depression.

00:42:49.920 There are many types of psychotherapy that we use for improving depression.

00:42:55.040 There are medications we have for improving depression.

00:42:57.460 These are all things that are well-supported in the evidence scientifically, and that we know what the downsides of them are very clearly, and you can make an informed decision around that.

00:43:08.220 Cannabis is not a treatment for depression.

00:43:10.400 It's not likely to improve your depression anything more than for a short period of time, which from my point of view as a psychiatrist, as a mental health doctor, is not treating your depression.

00:43:18.860 Making your symptoms go away briefly is a relief.

00:43:22.200 That's not really a treatment that's helpful for you in the long run.

00:43:25.220 If someone were to ask you straight up, is cannabis safe?

00:43:27.680 How would you answer?

00:43:28.540 I think we've kind of like seen that throughout this conversation.

00:43:31.560 You'd say it's nuanced.

00:43:32.600 It depends, right?

00:43:33.940 Yeah.

00:43:34.360 Is cannabis safe among over 25-year-olds?

00:43:37.460 If the cannabis that you're getting is of good quality, which I think is something that there's still the jury is out on, and you're ingesting it probably as like an, I would say certainly edible would be kind of the safest, and you're using it infrequently, it's probably safe.

00:43:56.840 The nuanced parts of it get into frequency of use, you get into the idea of how much you're really using it, because like anything, much like alcohol, the increased use just keeps increasing the negative associations.

00:44:11.400 And there's a tipping point, right?

00:44:12.420 So like a little bit of cannabis, I have this friend who's a pothead who always talks about the idea of like, you've got to find the magic space where you're using just enough where it's improving the quality of your life, but not so much where it's causing problems.

00:44:25.500 And I think that that line is not always clear to people.

00:44:28.700 If I were to make a general rule, right, if we're going to make a generalization, I think daily cannabis use is like red flaggy, like that's pretty concerning, particularly all day cannabis use.

00:44:40.860 So, you know, any of your audience that is waking up and getting high, which is a fairly common thing, that's concerning for a lot of reasons.

00:44:48.860 You're always hitting your cannabinoid receptors, you're not really giving them much of a break.

00:44:53.280 So daily use is concerning, weekly is kind of on the cusp, monthly, the data looks like there aren't many negative associations with that.

00:45:02.340 Well, Ryan, this has been a great conversation.

00:45:03.880 Is there some place people can go to learn more about what you're doing, your work?

00:45:06.820 Yeah, a couple of places.

00:45:07.980 You could go to the Columbia Psychiatry website and look up the Sultan Lab, and you can see our past projects, this project, and other projects.

00:45:15.920 If you're really nerdy, you can look up the actual paper that we did on this.

00:45:21.060 It's an open source paper.

00:45:22.640 Anyone can read it.

00:45:23.400 It's just a PDF.

00:45:24.380 So jam a network open, put in Ryan Sultan and cannabis use, and it'll come up.

00:45:30.480 Fantastic.

00:45:30.940 Well, Dr. Ryan Sultan, thanks for your time.

00:45:32.420 It's been a pleasure.

00:45:33.440 My pleasure.

00:45:35.140 My guest there is Dr. Ryan Sultan.

00:45:36.820 He's a clinical psychiatrist at Columbia University and the lead author on the study,

00:45:40.560 Non-Disordered Cannabis Use Amongst U.S. Adolescents.

00:45:42.980 You can find more information about his work at his website, the Sultan Lab at Columbia University.

00:45:47.500 We got a link to it in our show notes.

00:45:48.940 Also, check out our show notes at aom.is slash cannabis, where you can find links to resources,

00:45:53.060 where you can delve deeper into this topic.

00:45:57.420 Well, that wraps up another edition of the AOM Podcast.

00:46:00.260 Make sure to check out our website at artofmanly.com.

00:46:02.380 We find our podcast archives, as well as thousands of articles that we've written over the years

00:46:05.720 about pretty much anything you can think of.

00:46:07.540 And if you haven't done this already, I'd appreciate if you take one minute to give us a review

00:46:10.160 on Apple Podcasts or Spotify.

00:46:11.420 It helps that a lot.

00:46:12.080 And if you've done that already, thank you.

00:46:13.880 Please consider sharing the show with a friend or family member who would think we'd get

00:46:16.680 something out of it.

00:46:17.600 As always, thank you for the continued support.

00:46:19.480 Until next time, it's Brett McKay.

00:46:20.900 Remind you time to listen to the AOM Podcast, but put what you've heard into action.

The Art of Manliness - August 21, 2023

Is Cannabis a Safe Drug？

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